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THE 



CARE OF THE BABY 

A MANUAL FOR MOTHERS AND NURSES 



CONTAINING 

I'RACTICAL DIRECTIONS FOR THE MANAGEMENT OF 
INFANCY AND CHILDHOOD IN HEALTH 

AND IX DISKASK 



J V. CROZKR C.RIFFITH, M. D. 

Clinical ProfesiK>r of Diseases of Children in the Haspiul of the University of Penn- 
sylvania ; Physician to the Children"?. H<>spit.«l. to the Methodist Episcopal 
Hospiul, and to St. Agnes' Hospii.il. Philadelphia. Member 
o( the American Pediatric Society and of the 
Association of Anieiican Physicians 



SECOA'D EDITION, REVISED. 



PHILADELPHIA 

W. B. SAUNDERS 

925 Walnut Street 

189S. 



V A- 



1121 1 



Copyright, 1898, by 
W. B. SAUNDERS 




2n0 COP^. 

I »V0 COPIES RECEIVED- 1898. 

ELECTROTYPED BY 
WESTCOTT t THOMSON, PHILADA. 



PRESS OF 
W. B. SAUNDERS. PHILADA. 



PREFACE TO THE SECOND EDITION. 



The very gratifying success which the first edition 
has met has made the author desirous of bringing the 
present one thoroughly up to the demands of the times. 
He has therefore submitted it to a complete revision, 
enlarging it considerably and adding several new illus- 
trations. He would again emphasize the statement made 
repeatedly throughout the volume, that the chapter on 
''The Sick Baby" is not intended to supplant the physi- 
cian. This he considers impossible. It is designed 
especially for mothers in eineii'Liicv. where medical aid 
cannot be obtained. 



PREFACE 



The author has endeavored in the following pages to 
furnish a reliable guide for mothers anxious to infonn 
themselves with regard to the best way of caring for 
their children in sickness and in health. 

The first chapter of the book discusses the hygiene of 
pregnancy, the method of calculating the date of con- 
finement, and similar data. The characteristics of a 
healthy baby are considered in the second chapter, and 
the growth of its mind and body in the succeeding one. 
The chapters which follow relate to the methods of bath- 
ing, dressing, and feeding children of different 'ages, to 
the hours for sleeping, to physical and mental exercise 
and training, and to the proper qualities of the children's 
various nurses and rooms. A special effort has been 
made to emphasize details and to make them clear, 
complete, and thoroughly up to date. 

The chapter upon the baby's diseases has been written 
particularly for those mothers who, through various cir- 
cumstances, are unable to have a physician constantly 
within a moment's call. It contains a description of 
the symptoms by which we may know that disease is 
present; a consideration of the nursing of sick children; 

a concise resume of the commonest diseases of infancy 

11 



12 PREFACE. 

and childhood; and directions for the management of 
various accidents, including, among others, drowning and 
the swallowing of poisons. 

Such illustrations have been inserted as, it is thought, 
will make more plain the meaning of the text. To avoid 
repetition throughout the book, various recipes for food 
or medicine, as well as remarks on the employment of 
baths of various sorts in sickness, of poultices, disinfect- 
ants, massage, and the like, have been placed in the 
Appendix. Here also are tables showing the proper 
proportionate doses at different ages, the doses of many 
of the remedies most commonly given to children, the 
contents of the emergency medicine closet, etc. The 
numbered references scattered throughout the text of 
the book refer to corresponding paragraphs in the Ap- 
pendix. 

The author has endeavored to make his statements 
plain and easily tmderstood, yet scientifically accurate, in 
the hope that the volume may be of service not only to 
mothers and nurses, but also to medical students and to 
those practitioners whose opportunities for obser\ang 
children have been limited. With what his own ex- 
perience with children has led him to believe w^ould 
be most helpful, he has combined those teachings in 
other books of like nature which have seemed to him of 
most value; and he takes this opportunity to acknow- 
ledge his indebtedness to previous writers, not for- 
getting the contributors to the files of that excellent 
magazine for mothers, ' ' Babyhood. ' ' He would also 



PREFACE. 13 

express his grateful thanks to his colleagues at the Uni- 
versity of Pennsylvania and at the Philadelphia Poly- 
clinic and School for Graduates in Medicine, Professors 
Hirst, Roberts, Randall, Van Harlingen, and Risley, 
who have revised for him, with many valuable sugges- 
tions, the pages bearing respectively upon the hygiene 
of pregnancy and of the nursing mother, surgical affec- 
tions, diseases of the ear, diseases of the skin, and dis- 
eases of the eye. 



CONTENTS. 



I PAGB 

I Introduction 17 

CHAPTER I. 
Before the Baby Comes 19 

CHAPTER II. 
The Baby 34 

CHAPTER III. 
The Baby's Growth . 46 

CHAPTER IV. 
The Baby's Toii^et 66 

CHAPTER V. 
The Baby's Clothes S^ 

CHAPTER VI. 
Feeding the Baby 109 

CHAPTER VII. 
Sleep ... 157 

CHAPTER VIII. 
Exercise and Training, Physical, Mental, and Moral . 164 

i5 



1 6 CONTENTS, 

CHAPTER IX. 
The Baby's Nurses 182 

CHAPTER X. 
The Baby's Rooms .198 

CHAPTER XI. 
The Sick Baby 220 



APPENDIX 353 



THE CARE OF THE BABY. 



INTRODUCTION. 

It seems often to be taken for granted that the young 
mother will understand by a sort of intuition the care 
which her baby requires, as though it needed no more 
than a newborn animal of some lower order of life. The 
fact is that such a little animal, slight though its needs 
are when compared with those of a baby, has a parent 
which by instinct is far better able to care for it than is 
the human mother for her child. 

That she knows nothing is both the mother's safe- 
guard and her danger. Ready and anxious as she is to 
fit herself for her new duties, she is even by this anxiety 
rendered too ready to accept as gospel all that is told her 
about the care of her infant by those who assume to 
know, but who "darken counsel by words without 
knowledge." She thus becomes the prey of " old wives' 
fables" and of all sorts of gratuitous advice, the injuri- 
ousness of which is shown too late in the condition of 
the unfortunate child. 

A well-informed monthly nurse can be of great assist- 
ance to a new mother beginning the care of her baby. 
Unfortunately, not all nurses are of this class, and some 
are full of absurd and harmful practices and teach- 
ings, while even those who are intelligent and well 
trained often err greatly in many points. Of all this the 
mother is, of course, unable to judge, unless she herself 

2 17 



1 8 THE CARE OF THE BABY. 

knows what is right. The baby's grandmother is nat- 
urally rather rusty in matters relating to the care of chil- 
dren, although she may not be ready to admit it. 
Moreover, it is most true, in the words of the old song, 

that 

" Times have changed since then, 
And life is a different thing," 

and many methods which were considered entirely cor- 
rect years ago have since been greatly improved or even 
found to have been actually wrong. The mother there-, 
fore finds herself, after the departure of her nurse and 
physician, ignorant and without reliable resources upon 
which to draw. Such being the case, we may profitably 
consider, as briefly as possible with due regard to com- 
pleteness, some of the matters connected with babyhood 
from birth, and even before it, up to the time when 
childhood ceases. 

Baby is, indeed, a very indefinite term, often applied 
by mothers to children who have far outgrown their 
right to the name as strictly used. But "baby" the 
child still is to its mother, unless a second comer has. 
added dignity to the first-born's position, so "baby" it 
shall be to us in our present study of its wants ; for we 
must not forget that a child even of several years 
demands just as great care, although of a different sort, 
as it did when still in arms. 

From a strictly medical standpoint babyhood and 
childhood are very commonly divided into three jDeriods, 
concerning the exact limits of which physicians are not 
altogether agreed. Most conveniently we may speak of, 
first, mfancy^ which extends from birth to the age of tw^o 
years; second, early childhood^ from the age of two to 
that of six years; and, third, later childhood^ from the 
age of six years to that of puberty — that is, thirteen to 



BEFORE THE BABY COMES, 



19 



fifteen years. We shall repeatedly have occasion during 
our study of the subject to use these terms as thus 
defined. 

No observations made in the following pages concern- 
ing the baby when ill are intended to do away with the 
j physician any more than they are meant to make a 
! mother entirely dependent upon him. Their object is 
' only to help her understand what she can do without 
I medical advice, and how she shall do it; when she shall 
call a physician to her aid, and what she shall do before 
he comes. 



CHAPTER I. 
BEFORE THE BABY COMES. 

It is a fact which ought never to be forgotten that the 
proper care of the baby begins long before it is born, for 
to produce healthy offspring the parents must themselves 
be healthy. Although the manner of living always 
healthily is a subject far beyond the province of this 
volume, at least some attention must be given here to 
the way in which a woman should live after she has dis- 
covered that she is to be a mother. How she shall order 
her life should certainly be her first consideration, for, 
whether or not the coming of the baby is a welcome 
thought, her responsibility for the future welfare of the 
child that is to be remains the same. She has no right 
to act in any way that may injure another human life. 

Signs of Pregnancy. — Whether she is really preg- 
nant is naturally the first question, and one concerning 
which a woman does not ordinarily consult her physician. 
There are a large number of presumptive signs of preg- 
nancy, many of which she is capable of observing her- 



II 



20 THE CARE OF THE BABY. 

self. It is proper to remark that none of these indicate 
anything further than the probable existence of preg- 
nancy. There are only a i^^ positive signs, and these 
can be detected by the physician alone. 

The most striking and valuable of the presumptive j 
signs is, of course, the cessation of the monthly periods; 1 
yet even this is not entirely reliable, for various other • 
causes may account for it. It sometimes happens that ' 
menstruation is absent for several months in early mar- j 
ried life, and yet that conception has not taken place; \ 
while, on the other hand, the monthly periods occasion- ; 
ally come on regularly during a part or, rarely, all of j 
pregnancy, although in this case they are usually scanty ' 
and of short duration. Finally, a woman may conceive 
while still nursing and before menstruation has been 
re-established. As a rule, however, the cessation of j 
menstruation in a married woman previously regular "j 
indicates pregnancy. i 

Enlargement of the abdomen is another important ' 
sign, although usually not detected before the fourth j 
month of pregnancy. A valuable indication is enlarge- j 
nient of the breasts with tenderness of the nipples and a I 
decided widening and browning of the pink ring, or 
areola^ around them. Sometimes a small amount of a 
watery fluid is secreted later. The enlargement of the | 
breasts begins in some instances in the second month of ' 
pregnancy, and becomes quite noticeable in the fourth 
and fifth months. The alteration of the areola com- 
mences to be visible by the end of the second month. 

' ' Morning sickness " is a symptom present in many 
women. It usually consists in the occurrence of nausea, 
and perhaps vomiting, in the early morning, but it some- 
times lasts all day. It appears generally in the second 
month, occurs every day or less frequently, and lasts only 



BEFORE THE BABY COMES. 21 

through the third month ; but in bad cases it may con- 
tinue through the whole period, and become dangerous 
from the difficulty the patient experiences in retaining 
food. 

*' Quickening" is a sign of much value, but, like the 
others, only presumptive. By this term is meant the 
detection by the mother of the movements of the child 
within her. It was once thought that the child received 
life at this time, but this was, of course, erroneous. The 
child is just as much alive before quickening as after- 
ward, but its early movements are too feeble to be per- 
ceived until four or four and a half months after concep- 
tion. The movements at first give the sensation of a 
feeble fluttering, but soon become much more evident, 
and then feel like sudden, sharp strokes or kicks, and are 
often the cause of considerable or even great discomfort. 

There are a number of other less important presump- 
tive signs, such as variations in appetite, with abnormal 
hunger, or "longings," for unusual kinds of food. 
Again, the whole disposition may be changed completely 
for the time, and she who was formerly vivacious, 
cheerful, and good-natured may become dull and melan- 
cholic, full of the gloomiest forebodings, or excessively 
irritable. Sometimes, but, unfortunately, less frequently, 
just the reverse of this takes place, and the disposition is 
at the best during pregnancy. 

The exact time at which the baby may be expected is 
a matter of great importance, since so many preparations 
must be made for its arrival. Confinement occurs 272 to 
275 days from the date of conception; but, as this date 
can rarely be determined exactly, it is customar}^ to 
reckon that pregnancy lasts 10 menstrual months of 28 
days each — that is, 280 days — from the first day of the 
last menstrual period. This equals 40 weeks, or a little 



22 THE CARE OF THE BABY. 

over 9 calendar months. A ready rule for determin- 
ing the date on which confinement may be expected is 
to count three months backward from the first day of the 
last menstruation and to add seven days to the date 
obtained. Thus, if the last period began on February 
3, three months backward would bring it to November 
3, and seven days added would make November lo the 
probable date. Since, however, the months are not of 
equal length, various tables have been constructed for a 
more accurate and convenient method of computing the 
date. The one upon the opposite page is a form very 
commonly in use. 

This method of reckoning is, of course, only approxi- 
mate even when the exact date is known on which it is sup- 
posed that conception occurred. It is therefore only safe 
to consider the calculated date of confinement as the 
middle of a period of two weeks, on any day of which 
labor may naturally take place. Where it is impossible ■ 
to reckon from the last menstrual period, it is custom- 
ary to count from the date of quickening. Four and a 
half months from this date, or five months in the case of 
a woman pregnant not for the first time, will give the " 
approximate date of confinement, although this is not " 
very accurate. 

Management of Pregnancy. — The prospective mother 
has, then, forty weeks during which she shall conduct 
herself in the way that will exert the most powerful 
influence for good upon the health of the coming little j. 
one. Bathing in tepid water may be enjoyed daily, but i 
very hot or very cold baths, sea-bathing, and foot-baths \ 
are dangerous. Moderate exercise in the open air is im- ^ 
portant, while the constant occupancy of close, heated 
rooms is distinctly harm^ful. All the pure air possible 
should be obtained. Walking is beneficial, as is driving \ 






BEFORE THE BABY COMES. 



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24 THE CARE OF THE BABY. 

over smooth roads or riding in street cars; but horse- 
back riding, bicycling, dancing, driving over rough 
roads, lifting, straining of any kind, the use of the 
sewing-machine, and all other violent or long-continued 
forms of exercise ought sedulously to be avoided. Par- 
ticular care must be observed at the times at which the 
menstrual period would naturally occur if pregnancy did 
not exist. Sea-voyages are dangerous, on account of the 
liability to sea-sickness and the straining which accom- 
panies it. There is a very injurious custom among some 
women — that of refusing to go out of the house from the 
time when the alteration of figure becomes marked. 
Even were concealment of the figure impossible, health 
rather than appearance should be the first consideration. 

Amusement is, of course, necessary. There is no rea- 
son why pleasures should be abandoned, provided they 
are made entirely secondary to health. So, too, the fre- 
quenting of the theatre and of similar places of amuse- 
ment is often harmless, especially if it is found to exert 
no unduly exciting influence upon the emotions. In 
many women, however, the emotional nature is unusu- 
ally susceptible during pregnancy, and crowded places 
and exciting reading must be avoided. No amusements 
should be allowed to interfere with the obtaining of the 
large amount of sleep which is always required at this 
time. 

This brings us naturally to the consideration of the 
management of the mental condition. The unusually 
impressionable state characteristic of pregnancy renders a 
woman very prone to become the subject of great despon- 
dency. This she can relieve to a certain extent by the 
recollection that it is only a symptom shared by a great 
many others, and that there is no reason for the convic- 
tion that she will never survive the birth of her child. 



BEFORE THE BABY COMES. ±^ 

It is, of course, much easier to give this advice than to 
follow it. Consequently it is important that she avoid 
adding to her fears by listening to detailed accounts of 
the trials of other women under similar conditions, or 
by reading depressing novels or witnessing distressing 
sights. The experiencing of frights, the seeing of de- 
formed persons or animals, the hearing of bad news, and 
so on — maternal impressions^ as the doctors call them — 
are very commonly supposed to exert a powerful influence 
in producing some deformity or defect in the child; while 
the looking at beautiful objects, the listening to delight- 
ful music, and the reading of elevating books are also 
claimed to affect favorably the body or mind of the baby. 
As there is a possibility that such influences exist, every 
pregnant woman should avoid the one sort and cultivate 
the other. At the same time, there is certainly far more 
fable than truth in all this, and the action of such things 
is so infinitesimal and so uncommon that no woman need 
conclude that her child will surely be '^ marked " because 
she has been frightened or impressed in some way. The 
chances are hundreds of thousands to one that no such 
thing will happen. The various instances of maternal 
impression of which we so often hear are simply imagin- 
ary. On the other hand, there does exist the very cer- 
tain influence of inheritance. If a mother wishes her 
child to be healthy of body and beautiful of mind, she 
must previously have cultivated her own mind and body 
through years of training. 

The diet during pregnancy should be generous yet 
easily digestible. There is no reason why the usual diet 
should be altered at all, if it has been healthful and well 
assimilated, except that it is sometimes better to have 
the evening meal light. It is also wiser to eat meat only 
once a day, in order to throw less work upon the kidneys. 



26 THE CARE OF THE BABY. 

There is no truth in the fancy that certain articles of 
food eaten can exert any special influence upon the 
development of the child. 

The dress is very important. The skin should be well 
protected against change of temperature by wearing 
woollen clothing both in summer and in winter. All 
garments must be loose enough not to interfere in the 
slightest with the progressive enlargement of the abdo- 
men and breasts. No woman with the slightest regard for 
the health of her child or for her own safety will resort to 
tight lacing in the endeavor to conceal her state as long 
as possible. From the very beginning of pregnancy she 
should abandon the corset altogether or use one especially 
adapted to prevent pressure, and should avoid circular 
garters and suspend the clothing from the shoulders as 
far as possible. There are now various dress-reform sys- 
tems on the market which answer the purpose very well, 
and which are certainly to be commended during preg- 
nancy, even though a woman cannot persuade herself to 
wear them always. High-heeled shoes ought not to be 

worn, as they put a strain on the 
back and the pelvis and may do 
serious damage. With the ex- 
hibition of proper taste and skill 
the dress can be so fashioned 
that no woman need have cause 
Fig. i.-Abdomi„al b^ *« "^egaM herself as unfit to 

appear in public. 
The abdomen may grow very large, especially in 
women who have previously borne children, and may 
demand some support. A binder will give relief, or, bet- 
ter still, one of the abdominal supporters which are 
especially made for this purpose (Fig. i). A week or 
two before confinement the abdomen usually seems to 




BEFORE THE BABY COMES. 2 7 

grow a little smaller, the result of the settling of the 
womb lower into the pelvis. 

The care of the breasts must be commenced early, 
since upon this the ability to nurse the baby may largely 
depend. The entire removal of the pressure of the cloth- 
ing allows the breasts full opportunity to grow properly. 
They should, however, be covered warmly, and be well 
supported if their increasing size renders their weight 
uncomfortable. Particular attention must be given to 
the nipples, in order both to render them of a shape 
which the child can readily grasp and to make them 
secure later against the development of painful fissures. 
Sometimes there is a tendency to the formation on the 
nipples of a large amount of scaling skin. These scales 
must be washed away frequently if they show a disposi- 
tion to adhere. If, as the breast grows, the nipple is 
found not to stand out well, a nipple-protector of some 
sort may be worn constantly as an additional safeguard 
and aid to development. This should not be done except 
by medical advice. In cases of flat nipples it is frequently 
of advantage to endeavor every day to pull them very 
gently with the fingers out from the breast. Another 
excellent plan for accomplishing this end is the use of 
a breast-pump. The form shown in the illustration 
(Fig. 2) is one of the best, as 
some pumps are too powerful 
and are apt to do injur}^ Trac- 
tion by the fingers or by the 
pump should not be used in a 
way to do the slightest harm, 

^ ^ Fig. 2. — Breast-pump. 

and no treatment of this sort 

should be begun until the last four weeks of pregnancy, 
lest a miscarriage be produced in women liable to it. 
With the beginning of the last month a hardening pro- 




28 THE CARE OF THE BABY. 

cess for the nipples ought to be instituted, in order to 
prevent the formation of fissures later. A useful plan is 
that of applying, morning and night, a tannin solution 
(Appendix, 73) to the nipples with a piece of absorbent 
cotton. 

The question often arises whether there is any way of 
determining the sex of the coming child, or any course 
which the mother can pursue to influence it. The very 
fact that so many different methods are heard of is excel- 
lent proof that none of them are good for much. The 
truth is that there is absolutely no reliable means known 
to medical science for discovering in advance whether the 
child will be a boy or a girl, and not the slightest power 
of doing anything that will have an iota of influence 
in producing a child of the desired sex. 

Disorders of Pregnancy. — There are many discom- 
forts of pregnancy for which the sufferer herself may be 
able to do much. If simple means do not avail, she 
should not neglect to consult her physician, for there is 
surely no need of enduring any inconvenience that can 
be avoided. Constipation is exceedingly common at this 
time. The use of some laxative food, such as oatmeal por- 
ridge, green vegetables, figs, oranges, or stewed fruit, 
especially prunes, is often sufficiently effective. If not, 
mild drugs may be used without danger, as, for example, 
Seidlitz powders, or such mineral waters, in small doses 
before breakfast, as Hunyadi, Rubinat, Friedrichshall, 
and the like, or some gentle laxative pill prescribed by 
the attending physician. All strong purgatives and 
patent medicines are to be shunned. Enemata of tepid 
water may be used safely. Suppositories of glycerine or 
of gluten, or very small glycerine enemata are also of 
service. 

Irritability of the bladder is very common. It is relieved 



BEFORE THE BABY COMES. 29 

to some extent by the recumbent position, which takes 
away the pressure of the heavy womb. If the urine is 
high-colored and causes smarting, a physician's advice 
should be had. Hemorrhoids, or piles, not infrequently 
develop in the later months of pregnancy. Ver)^ hot 
fomentations or sponging with very cold water, done fre- 
quently and followed by boric-acid-and-zinc ointment (Ap- 
pendix, 71) often affords great relief. Rest in the recum- 
bent position is also of value. If the bowels are kept reg- 
ular and all straining is avoided, hemorrhoids will not be 
so liable to form. Varicose veins or a painful swelling of 
the legs and lower parts of the body is often very annoy- 
ing as pregnancy advances. Rest lying down is one of 
the best means of relief, as is rubbing of the legs in an 
upward direction. It is often necessary to apply a soft 
flannel roller bandage from the toes nearly to the hips. 
This should be done before getting out of bed in the 
morning. If varicose veins grow at all large, a physician 
should be consulted, as there is danger of their bursting. 
Should the face swell, as well as the legs, it is probable 
that the kidneys are affected. As this is a dangerous compli- 
cation, no time should be lost in obtaining medical advice. 
Indeed, a specimen of the urine should be sent to the phy- 
sician from time to time during pregnancy, to make sure 
that no disorder of the kidneys is insidiously developing. 
A profuse flow of saliva sometimes occurs. It is occa- 
sionally relieved by a mouth-wash of tincture of myrrh in 
water. Toothache is not infrequent. If neuralgic only, 
it is often relieved by the use of a hot- water bag; but, 
unfortunately, it is not always of this nature. Decay of 
the teeth is very apt to occur during pregnancy, and it is 
best to consult a dentist occasionally, even though there 
be no toothache. No painful dental operation should be 
undergone if it possibly can be avoided. 



30 THE CARE OF THE BABY. 

It sometimes happens that the hair falls out badly dur- 
ing pregnancy. This, like the toothache, may be only a 
temporary matter; but as it may be permanent, it is well 
to receive treatment for it. 

There is no reason whatever why a woman should suf- 
fer from morning sickness without at least making an 
effort to have it relieved. A plan frequently effectual is 
to take a cup of coffee, tea, broth, or hot milk early in 
the morning, without sitting up in bed, and then to rest 
or to sleep again for a short time before rising. If the 
vomiting persists during the day, food ought to be taken 
in very small amounts at frequent intervals. Of course, 
too, the food ought to be digestible and the bowels kept 
regular. Should the vomiting be severe and not be 
relieved in the way mentioned, medicines ordered by the 
physician will often control it. 

Heartburn and other evidences of indigestion, which 
are quite common in pregnancy, are often promptly re- 
lieved by soda-mint, and, if not, they should be prescribed 
for by the attending physician. Leucorrhoea is sometimes 
decidedly troublesome and even very irritating. Injections 
should not be used unless ordered by a physician, and 
then only with a very gentle stream from a fountain 
syringe (Fig. 3). The bag of the syringe must never be 
elevated more than a foot or two above the hips. Exter- 
nally, a solution of boric acid 
in water (Appendix, 75) may 
be used for bathing if there is 
any soreness, followed by the 
application of an ointment of 
oxide of zinc or of a pow^der of 
talc. 

Fig. x. — Fountain s^Tinge. _ . . ^ ^ ^. 

^ ^ ^ Preparations for Confine- 

ment. — Finally, we must consider briefly some of the va- 




BEFORE THE BABY COMES. 31 

rioiis preparations to be made for the confinement itself. 
The following list comprises the articles for the mother's 
use that should be provided in advance: 

Hand-towels. 

Ether, one-half pound. 

Brandy, two ounces. 

Vinegar, four ounces. 

Antiseptic tablets (corrosive sublimate), one bottle. 

A large, coarse new sponge. 

Braided silk, or a skein of bobbin (for tying the cord). 

A fountain syringe. 

A new soft-rubber catheter. 

One or two china basins. 

A porcelain bed-pan. 

Absorbent cotton, small package. 

Salicylated cotton, one-pound package. 

Carbolized gauze, one can. 

•New rubber cloth, one yard wide, two yards long. 

Nursery cloth, eight yards (for pads). 

Unbleached muslin, two yards (for binders). 

Carbolized vaseline, one-ounce bottle. 

Large oil-cloth or old rug (to protect the carpet). 

Large safety-pins. 

Fluid extract of ergot (bought one week before con- 
finement). 

Hot water in abundance (at time of confinement). 

The room which the prospective mother will occupy 
will ordinarily be her usual bed-room. It ought to be 
light, well ventilated, and large. It is a great conve- 
nience if there is an adjoining room for the monthly 
nurse, as this leaves to the mother the exclusive use of 
her own. The bed, when ready for the confinement, 
should be so situated that it is out of draughts and that 
its sides are not against the wall. The mattress should 



32 THE CARE OE THE BABY. 

be of hair or other firm material, but certainly not of 
feathers; and extending entirely across it, at the level of 
the hips, there should be the strip of rubber cloth. 
Over this is spread the lower sheet of the bed, and finally, 
on the spot where the hips will lie, a protecting pad for 
the purpose of catching and absorbing the discharges. 
This pad should be a yard or more square. It is made of 
nursery cloth, and is pinned to the sheet with safety-pins. 
Under the bed is placed the oil-cloth or old rug. Many 
of these arrangements for sparing the bed and the floor 
are sometimes substituted by special rubber apparatus. 

The ' ' nursery cloth ' ' referred to consists of two layers 
of muslin with a layer of cotton quilted between them. 
It may be bought in the shops. It should be boiled for 
half an hour in a clothes-boiler, dried thoroughly, pinned 
up in a sheet, and put away out of the dust. 

The napkins which the mother will use should not be 
made until just before the confinement. She must, when 
making them, see that her hands are very clean, and she 
should put them away, when finished, in a clean place 
free from dust. It is far better, indeed, that the nurse 
make the napkins as needed. Each one is composed of 
an oblong wad of salicylated cotton enveloped in carbol- 
ized gauze folded in the usual form. All soiled napkins 
must be burnt at once. 

The abdominal bandages or "binders," of which there 
should be several, are composed of washed unbleached 
muslin half a yard wide and two or three feet long. 

If the nurse is in the house some time before the con- 
finement, as she should be, she will decide when to send 
for the physician, and thus relieve the patient of respon- 
sibility in the matter. If she has not yet come, the pro- 
spective mother will suspect that labor is about to begin 
from the occurrence of true pains. These are felt 



BEFORE THE BABY COMES. 33 

either in the back or in front, last a quarter to half a 
minute, and come on rather regularly. The intervals 
between them at first last, perhaps, three-quarters 
of an hour, but gradually grow shorter, while the 
pains grow more severe and centre more and more in 
the back. There is often a slight discharge of blood 
(sometimes called a '' .show"), which is almost a positive 
proof that labor is about to commence. False pains^ 
as they are usually called, quite frequently occur at inter- 
vals during the two weeks before confinement. They are 
situated in the abdomen and have no element of regu- 
larity about them. 

The "bag of waters" is a sac containing a peculiar 
fluid in which the child floats. Its rupture is indicated 
by a continuous flowing or sudden gush of liquid. Should 
this happen, the physician must be sent for at once, even 
though there has been little or no pain. The rupture 
may take place, it is true, some days before the child is 
born, but much more frequently it does not occur until 
labor has really commenced, or even is nearly over. 

At the very beginning of the confinement the bowels 
ought to be emptied by an enema unless they have been 
moved just before. 

After labor is actually under way and the physician 
has arrived the patient has no further responsibility, and 
we need not consider the treatment that she requires or 
the various steps in the birth of the child. After its birth 
her physician will still attend to her needs and prescribe 
the form of diet best suited to her. When she is out of 
bed again and thrown on her own responsibility, her 
chief care for herself with regard to the baby must be to 
retain for it a suitable supply of milk. This can be dis- 
cussed more conveniently in the chapter which treats of 
Feeding the Baby. 



34 THE CARE OF THE BABY 

CHAPTER II. 
THE BABY. 

The new-born baby is certainly not an object of 
beauty. Even its mother could hardly think it so, did 
she vsee it at the moment of its birth, before it has expe- 
rienced the improving influences of its first toilet — wet 
and more or less covered, as it is, with a peculiar whitish, 
waxy material. After it is washed and dressed its appear- 
ance even yet cannot be called altogether prepossessing. 
Still, despite its lack of beauty, its mother loves it and 
is naturally anxious to know whether it is ''all right." 
Many times afterward will she be fortunate if she can tell 
whether all is still right with it. As without a knowledge 
of how a baby of any age should look and act it is impos- 
sible to recognize illness developing, our first duty is to 
pass in review the characteristics of a healthy child — 
often called the features of health. 

A healthy and well-developed new-born infant should 
be plump and firm, with its bones well covered and with 
a soft and extremely delicate skin. This remarkable 
softness is due in great part to the presence everywhere 
of a coating of fine down, which is sometimes scarcely 
visible, sometimes quite abundant. The skin is of a 
decidedly reddish color, and only when the baby is 
suffering from some disease or when it is cold does it 
become mottled or bluish. Cold is the most frequent 
cause of this, for a baby has but feeble vitality as com- 
pared with an adult. 

The baby should weigh anywhere from 6^ to lo 
pounds, the average being 7^ pounds." Its length is 
about 19 inches, with a range, however, of from 16 to 22 
inches. Any child which comes within these limits of 



THE BABY. 35 

weight and length is to be called normal. Occasionally 
these figures are much exceeded, but not often. It must 
be remarked, too, that a child may be thin when born, 
and yet not be actually unhealthy. 

Before the child is a week old its lobster-red color often 
fades into a no more attractive, yellowish-red tint which 
makes it look almost as though it had an attack of jaun- 
dice. This is not jaundice, however, for the whites of 
the eyes show no trace of yellow. In this first week, 
also, the long down begins to fall out, and a more or less 
extensive shedding of the skin takes place, generally in 
the form of fine scales, but sometimes in shreds. This 
shedding always occurs, and may last a week or more, 
although with many babies it is almost imperceptible. 

By the time the baby is about two weeks old the yel- 
low tint has disappeared and the skin has taken on the 
real "baby" character which is so much admired, and 
which only needs to be seen to be appreciated. It is then 
of a clear, soft, pinkish-white tint, with the palms, soles, 
and cheeks of a deeper rose. A warm bath or rubbing 
the skin renders the whole body reddish. 

There are many other features about the body of a 
healthy baby with which we must acquaint ourselves, 
for, although they may seem rather uninteresting, they 
are matters of the greatest importance. 

The head is remarkably large as compared with the 
rest of the body, being, indeed, nearly as long from the 
crown to the chin as is the trunk. Immediately after 
birth, if this has been difficult or prolonged, the head 
is sometimes found squeezed into a shape which is start- 
ling, it is true, but which need cause no anxiety. (See 
Chapter XL, p. 277.) 

The contour of a baby's head as seen from above 
should be round or oval. At the back of the head and 



36 



THE CARE OF THE BABY. 




at a point just behind the forehead are two spots where 
there is no firm bone present, and only the skin and a 

thin membrane cover the brain, 
which can be seen to pulsate 
through them. These spots are 
called the anterior and posterior 
fontanelles (Fig. 4). The first, 
the one just back of the fore- 
head, is the larger of the two, 
and is the only one to the size 
of which the mother need give 
any attention. It is diamond- 
shaped, and should measure 
from one-half to one inch, or 
even two inches, in diameter 

Fig. 4.-Infant's skull: anterior soon after birth. It should 

fontaneiie above; posterior fonta- neither be mucli depressed uor 
nelle below. bulge much. The' new-born 

baby sometimes has a very considerable amount of hair 
on its head. The mother need feel no alarm at seeing 
this fall out to a great extent in a short time. Its nails, 
too, are well formed at birth, and grown fully out to the 
ends of the fingers. 

The tongue during the first week of life — and, indeed, 
up to the time when saliva becomes more abundant — is 
more or less covered with a whitish fur. This is no sign 
of digestive disturbance, but is probably the result of the 
greater dryness of the mouth present at this time of life. 
The chest of a baby is poorly developed as compared 
with the head, and its circumference is somewhat less. 
The shoulders and hips are narrow, and their girth is at 
first less than that of the head. On the other hand, 
the abdo7nen is large and prominent, the result chiefly 
of the extraordinarily large liver which a new-born 



Plate I. 




Baby a few weeks old, showing the natural curve of the legs with the bending in of the 
•oles. (From a photograph.) 



THE BABY. 17 

child possesses. The arms are comparatively short, and 
the legs particularly so. The latter measure very little 
more than the length of the trunk. 

Every mother should remember that the baby at first 
has crooked legs, or rather what seem to be so, and that 
there is no cause for alarm on this account. It has the 
peculiar monkey-like power of turning its feet in in a 
way which brings the soles rather closely together. The 
accompanying illustration of a perfectly healthy and well- 
developed baby a few weeks old (PI. I.) shows the natural 
bowing of the legs. 

Of course there are such things as clubbing of the feet 
and bowing of the legs, but these are actual deformities 
of the joints and bones, not deceptive appearances merely. 

All these various peculiarities of shape which we have 
been considering change gradually with the growth of 
the child. We shall need to study them more fully in 
the next chapter. 

In addition to the features mentioned, it is necessary 
to know something of the expression of face and the 
position and gestures of a healthy child. The face of a 
very young baby when awake has an expression of 
wondering surprise. The look of intelligence which is 
there is only an apparent one. It is a pity, perhaps, to 
shatter a mother's fancy that her child notices what is 
going on, recognizes her, and expresses pleasure at her 
approach; still, the truth is that the baby at birth is 
about as intelligent as the sensitive plant, the leaves of 
which automatically close when touched. Like the 
plant with its leaves, the baby automatically closes its 
mouth and nurses without knowing that it does it. 

The color of the eyes is generally a very indefinite one 
— a sort of blue in all babies. However much they may 
be supposed at first to resemble the father's or the 



38 THE CARE OF THE BABY. 

mother's, a change to a lighter or a darker hue is liable 
to occur at the age of seven or eight weeks. When a 
baby of any age is asleep its eyes are entirely shut and 
the expression is that of peaceful repose. The posittoft 
of its body, too, at this time is that of entire and graceful 
relaxation. The head is usually turned slightly to one 
side, and breathing goes on almost imperceptibly and 
without any movement of the nostrils. In the waking 
state the new-born baby is comparatively still, except 
for a .really remarkable disposition to grasp anything 
with which its hand conies in contact. In a very short 
time, however, it becomes when awake almost the em- 
bodiment of perpetual motion, the legs and arms being 
in nearly constant although purposeless action. 

The first act of the new-born child usually is to cry. 
No sound is so pleasing to the attending physician as a 
good, lusty cry from the little newcomer, for it shows 
that it has well entered on the use of the lungs which 
have hitherto been inactive, and that it has plenty 
of strength for all the functions of its new life. The 
mother likes to hear it too — better than she will later. 
There is good cause for the baby's crying at such a time, 
for the change from its previous existence to the contact 
with the chilling external air, and the comparatively 
rough handling which it receives, must constitute an ex- 
ceedingly disagreeable experience. The sound soon 
ceases, however, after the child is washed and dressed and 
put to rest. It may be taken as a positive rule that a 
baby does not cry without some reason. A cause exists, 
although it may be a trivial one, and the cry is the baby's 
only audible means of expressing its dissatisfaction with 
its state. The cry should be clear, and any alteration 
from the normal tone is a valuable indication that some 
diseased condition is present. What these alterations 



THE BABY. 39 

are, and what they mean, we shall consider when we 
come to study the baby's illnesses. It is a curious fact, 
which may be mentioned here, that a young infant sheds 
no tears, no matter how hard it may cry. 

Finally, we must consider some matters connected 
with certain of the functions of life — namely, breathing, 
the action of the heart as shown by the pulse, the opera- 
tions of the bowels, the voiding of urine, and the condi- 
tion of the temperature. 

The respiration during sleep is quiet and comparatively 
regular. In the waking hours it exhibits a very great 
irregularity, which is present up to several years 
of age, although most marked in the first twelve 
months. The child often holds its breath a moment, 
yet, apparently, without any effort or any intention of 
doing so. A number of quick breaths may occur to- 
gether, or perhaps a number of slow ones. No weight 
whatever is to be attached to this peculiarity, for it is 
entirely characteristic of infancy and early childhood. 

The respiration in children up to the age of puberty is 
what is called abdominal ; and this applies to girls as 
well as to boys. The heaving movement is seen nearly 
entirely in the abdomen, the chest remaining compara- 
tively still. After girls reach the age of from thirteen to 
fifteen years the respiration is more from the chest, as it 
is in women. 

The rapidity of breathing in children varies with the 
age, as can be seen from the following table: 

Number of Respirations per Minute. 
At birth and for the first 2 or 3 weeks . . 30 to 50, average about 44. 
During the rest of the first year . . . . 25 to 35, average about 30. 

1 to 2 years About 28. 

2 to 4 years About 25. 

4 to 15 years 20 to 25. 

Adult life 16 to 18. 



40 THE CARE OF THE BABY. 

All these rates are from one-fifth to one-quarter less when 
the child is asleep, at least up to the age of four years, 
although after this the breathing is still slightly slower 
during sleep. The numbers given are average and 
approximate ones only, for the rate varies extraordinarily 
in young children. To estimate the frequency of the 
breathing we may watch the in-and-out movements of 
the abdomen, or perhaps put the hand lightly there and 
feel them. It is necessary to avoid the slightest excite- 
ment, since this increases the rapidity very greatly. 
During' sleep is an excellent time for making the obser- 
vation, allowing for the differences mentioned. 

"^^^^ pulse shares to a great extent the irregularity of 
the respiration, and the slightest excitement, such as cry- 
ing or even sucking, increases its rate so much that no 
conclusions can be drawn from any observations made 
under such conditions. The less the age the truer this 
statement is; and a mother consequently need feel no 
anxiety if her child of two or three years or less has a 
temporary pulse-rate of 20, 30, or even more beats per min- 
ute above the standard. Not only is the pulse influenced 
by excitement of any sort, but even when the baby is 
asleep or is perfectly quiet a decided irregularity can be 
perceived, which is perfectly natural and to be expected, 
although it would be abnormal, and perhaps dangerous, 
in an adult. The pulse may be felt at the wrist, or, when 
this does not succeed — as it often will not in the first 
weeks of life — in the neck or over the heart itself 
Another very good method is to watch the beating of the 
fontanelle. 

The table which follows shows the normal average 
pulse-rate at different ages. 



THE BABY. 4 1 

Number of Pulse-beats per IMinute. 

At birth 130 to 150 

First month 120 to 140 

I to 6 months About 130 

6 months to i year About 120 

1 to 2 3'ears no to 120 

2 to 4 3'ears no 

6 3'ears 100 

8 years 88 

14 years 87 

Adult life 72 

This table ^^^ives the pulse-rates in children who are awake 
but perfectly quiet. The figures are even more approxi- 
mate than in the case of respiration, owing to the great 
tendency to irregularity referred to, and to the extreme 
difficulty experienced in finding the quiet state desired. 
For this reason the best time to count the pulse is when 
the child is asleep. We must remember, however, that 
sleep produces a decided lessening of the speed. In chil- 
dren under nine years of age the slowing is 16 or 20 beats 
per minute; from nine to twelve years it is about 8 beats; 
and from twelve to fifteen years, 2 beats. The rapidity 
of the pulse is slightly greater in girls than in boys of 
equal age, but the difference is not very material. 

The boivcls of a new-born baby are generally opened 
once or twice during the first day of life. The passages 
of the first two or three days consist of a peculiar thick 
and sticky, odorless, blackish or greenish-black sub- 
stance called )iicconium. This was produced in the bowel 
before the birth of the child. When the flow of mother's 
milk has been established the passages become canar3^- 
yellow in color, of the consistency of thick cream, have 
very little odor, frequently contain small masses of undi- 
gested milk if the baby is getting more nourishment than 
it can entirely assimilate, and number two to four in 



42 THE CARE OF THE BABY. 

twenty-four hours. Gradually the frequency diminishes, 
so that from tSe age of six weeks or two months to that 
of two 3^ears there are usually only one to three move- 
ments daily, while the color is a trifle darker yellow, 
the consistency greater, and the odor rather more fecal. 
It is only after the age of two years, and when the diet 
has been considerably varied, that the passages become 
completely formed and of a distinctly fecal odor. There 
should never be any fetid odor from a natural and per- 
fectly healthy bowel-movement of a baby. 

Nevertheless, the number of movements of the bowels 
may vary considerably from the statements just made 
without indicating actual ill-health. There may be no 
more than one or two movements daily, even in early 
life, or they may number even five or six, and yet not 
constitute diarrhoea unless their character is also changed. 

The urine of a young healthy baby is generally almost 
like water in appearance, unirritating, has very little 
odor, and leaves no stain upon the diaper. Although it is 
generally passed within the first twenty-four hours, it not 
infrequently happens that the bladder is not emptied 
during the whole first day of life. This need not occa- 
sion any alarm, provided the baby is resting comfortably 
and is evidently in no distress. Just how often in twenty- 
four hours a baby usually passes water it is very difficult 
to state. Not only does it vary greatly with diiferent chil- 
dren, but with the day as well, depending upon the tem- 
perature of the air or upon the amount of nourishment 
taken. The average is probably six to ten times a day, 
but there may at times be an evacuation of urine every 
hour, or perhaps not for even ten hours, and yet the 
child be in perfect health. As age increases and control 
of the bladder is acquired the frequency diminishes to 
about six times a day or less. 



THE BABY. 43 

The amount of urine evacuated varies with the ao^e, 
although not exactly in proportion to it. The following 
table shows approximately the amounts for different 
periods of life: 

Amount of Urink Passed Daily. 

Birth to 2 3'ears 8 to 12 ounces. 

2 to 5 3'ears 15 to 25 

5 to [o 3'ears 251035 

10 to 15 years 35 to 40 " 

Adult life 52 

Every mother should be acquainted with the normal 
tcmper-ature of a baby, in order that she may be able to 
appreciate the changes occurring in disease. There is no 
way of determining this except by the clinical thermom- 
eter, for it is impossible for her even to approximate it 
satisfactorily by simply placing her hand upon the skin. 
Even the fact that a baby's hands and feet are cold is not 
sufficient proof that it is not having high fever at the 
same time. A clinical thermometer should be in every 
household, and the mother should thoroughly understand 
its use and should employ it whenever the child seems at 
all ailing. The instrument commonly used is self-regis- 
tering; that is, the top of the column of mercury, which 
indicates the temperature attained, will remain at the 

95 too us 

Fig. 5. — Clinical thermometer. 

highest point reached, even after the thermometer is 
removed from the child. The instrument is entirely 
of glass, without any outside casing, and the Fahrenheit 
scale is engraved upon the tube, dividing it into degrees 
and fifths of a degree (Fig. 5). The arrow on the tube 
merely points to what is considered nonnal — that is, 



44 THE CARE OF THE BABY. 

98f °. It may be disregarded altogether iu making the 
reading. The ordinary pattern is both stronger and less 
expensive than the more delicate "one-minute" ther- 
mometer. Very good instruments of the latter sort 
and of reasonable price can, however, be had, and these 
have the great advantage of requiring a shorter time 
to register, although they are somewhat more fragile. 
Many of the instruments have the stem so shaped that 
the front acts like a lens and magnifies the column of 
mercury, in order to make the reading more easy. 
This adds to the expense and is not at all necessar}'. 

The temperature may be taken in the arm-pit, mouth, 
or bowel. The first locality should ordinarily not be 
chosen for children, as the results obtained are often very 
misleading, owing to the difficulty experienced in bring- 
ing and keeping the surfaces of skin close together and 
thus excluding the air. The thermometer may be placed 
in the mouth of children of five or six years, who can be 
trusted not to bite upon it. To employ it the child 
should be seated or, still safer, made to lie down. The 
instrument should now be held firmly by its upper por- 
tion between the thumb and forefinger, and be swung or 
shaken forcibly until the column of mercury is made to 
descend in the tube far enough to bring its upper extrem- 
ity to 95° or thereabouts. The child now receiv^es the 
bulb under the tongue, and is told to close the lips upon 
it, but not to bite it. Very often the order will be under- 
stood better if the child is bidden to hold the instrument 
with one hand and to suck it "like a stick of candy" — 
that being an action with which every child seems famil- 
iar. The thermometer should be left in place at least 
four minutes, or, in the case of the more delicate instru- 
ments, two minutes. 

With younger children or those who, through sickness. 



THE BABY. 45 

cannot be entrusted with the thermometer in the mouth, 
the temperature is more conveniently taken in the bowel. 
To do this the child is laid upon its back or side in the 
lap or on the bed and its thighs are flexed. The bulb, pre- 
viously oiled, is then gently inserted an inch or two by a 
screwing movement. The procedure is simple, painless, 
and free from danger. Although it is better to be sure 
that there are no fecal contents in the rectum, it is not 
necessary to remove them by injection, provided the ther- 
mometer be left in place somewhat longer — at least five 
minutes in all. If no feces are present, the time men- 
tioned for the mouth is sufficient. The thermometer 
should always be washed thoroughly with soap and cold 
water after use, disinfected with a boric-acid solution (Ap- 
pendix, 75), shaken down well, and placed in its case. 

The normal temperature of a baby fluctuates consider- 
ably during the first week of life, but then settles down 
to from 98° to 99° F., as in the adult. We must remem- 
ber, however, that children are liable to have their tem- 
perature elevated some fifths of a degree by slight causes, 
such as hard crying or struggling against the use of the 
instrument, or even by the taking of a large amount of 
nourishment, although these variations are not so apt to 
occur as in the case of the respiration and the pulse. 
There is, beside this, a regular variation during the 
twenty-four hours, which is present in adults also, but is 
less marked. The normal temperature rises slightly 
in the small hours of the morning, reaches its highest 
point early in the day, sinks again in the evening, and 
is at its lowest during the night. There may thus be a 
difference of one, two, or even three degrees between the 
readings at different times of the day. It is important to 
bear all this in mind, or we might become very unneces- 
sarily worried. We can feel assured that a temperature 



46 THE CARE OF THE BABY. 

of 97.5° to 99° in the evening and 98° to 99.5° in the 
morning may be considered normal. It is only when 
a temperature of 100° is attained that we talk of 
fever. The signification of febrile temperatures in 
children we shall consider when we study the Sick 
Baby, in Chapter XI. 

Most of what has been said in this chapter relates to 
the baby while still very young. All the features de- 
scribed alter gradually with the increasing age of the 
child. The subject of the growth of the baby with the 
interesting changes which take place is so important that 
it must be considered in a chapter of its own, although a 
few of the progressive alterations, including those in 
pulse, respiration, temperature, urine, and bowel-move- 
ments, have been more conveniently discussed in this ' 
chapter. 



CHAPTER III. 
THE BABY'S GROWTH. 

Fortunately, the baby grows; for, charming as is 
its early helplessness, how much more delightful to 
watch the development of its beauty, strength, and in- 
telligence ! What mother will forget her happiness at 
the baby's first tooth, its first step, and its first word ! 

But all this progress comes only gradually; it is bit by 
bit that the child grows. By growth here is not meant 
increase in size and weight alone, important as these are. 
The baby's mind steadily grows, and the changes in it 
are even more remarkable than those of the body. The 
watching of this mental development is most interesting 
if we really appreciate just what the baby knows and just 
what it ought to know at different periods of life. 



THE BABY'S GROWTH. 47 

Besides all this growth of what is already present to 
some extent, new acquisitions appear, such as the teeth, 
tears, saliva, and the ability to walk; and still other 
changes go on which are not actually visible, such as 
alterations in the digestive powers. 

When the baby is just born, and during the first few 
days of life, it is, as stated in the preceding chapter, very 
little more intelligent than a vegetable. Its soul and its 
intellect are there, but they are dormant, waiting to be 
awakened. It has also little control over its body, and 
all its movements are automatic or instinctive. Probably 
there is not a single expression of the face or motion of 
the arms or legs which represents a distinctly willed 
action. Supported in the arms, the child cannot hold 
its head upright, but lets it roll from side to side as 
though in danger of snapping it off. The child lies just 
as it is placed in bed, unable to change its position. A 
new-born baby probably cannot see except to dis- 
tinguish light from darkness, and will not wink when the 
finger is brought close to its eyes. It seems also unable 
to hear, and at first cannot smell, although taste is well 
developed. It is, in fact, not directly conscious of any- 
thing. When it nurses at the breast it does not know it 
is nursing, and when it cries it is ignorant of any sensa- 
tion that makes it cry. When it moves its arms and 
legs strongly during nursing, or when it throws its head 
back or lifts its hand in response to a forcible touch- 
ing of its nose, or when it takes hold of anything placed 
in its palm, it is not because it wishes to express eager- 
ness for anything to eat, or to move its head out of the 
way or to close its fingers, but simply because it cannot 
help it. 

It is not long, however, before an interesting change 
begins. There is seen a distinct increase in the power 



48 THE CARE OF THE BABY. 

of control over the members. By the time the baby is 
three months old, or sometimes a little before this, it 
gradually begins to make efforts at grasping after objects, 
although totally unable to judge whether they are near 
or far away, and by six months it can make many 
well-directed movements and will play with toys. Before 
the age of two months the baby has evidently gained 
considerable power in lifting its head, and by that of 
three or four months it can hold it without support very 
well. It usually does not attempt to sit up until it is 
between three and four months old, and does not succeed 
in doing so until at least six months old. Even then it 
is not very steady, and is easily upset until the age of 
nine or ten months. 

At about six months the baby will sometimes make 
an effort to stand, if held upright on its feet in the 
mother's lap, and will try to put one foot in front of the 
other. At seven or eight months it begins to creep on 
its hands and knees, and by nine or ten months of age is 
often able to stand with support, and frequently to walk 
some steps by holding to the furniture or to some one's 
hand. By the age of one year strong children can walk 
a little without help. 

There is no absolute rule, however, for the time or for 
the exact order of learning to creep and to walk. Many 
children are very slow in walking, particularly if they 
have become expert and rapid crawlers, while some do 
not creep at all, but learn first to stand and then to walk. 
A mother should be in no hurry about the matter. Fifteen 
to eighteen months is really quite early enough for walk- 
ing, and some children do not learn until two years of 
age, and yet are perfectly healthy. Nevertheless, as great 
a delay as this latter cannot but lead to the suspicion that 
something is wrong with the child's development. 



THE BABY'S GROWTH. 49 

It is a curious observation that when babies fall during 
their early efforts at walking they nearly always go back- 
ward into a sitting position. This is due to the fact that 
the muscles of the front of the leg have not yet become 
as strong as those of the back. Every child also naturally 
walks "pigeon-toed," and the learning to turn the toes 
out is always a slow matter. 

With the increasing power and control of motion there 
is a development of the senses also. By the age of six 
weeks or earlier the baby can fix its eyes upon objects 
near it, and will quickly shut them if something is 
moved rapidly toward them, and by the age of two 
months its vision is nearly perfect, although colors prob- 
ably cannot be distinguished at all until the age of a 
year, and the color-sense even after this increases slowly 
in many children. Hearing and the sense of smell de- 
velop rapidly, and within the first week the baby will be 
awakened by loud noises. It does not begin, however, to 
notice the character and the direction of .sounds until it 
is three months old. Musical tones arc sometimes recog- 
nized between the ages of one and two years, and a child 
of two or even less may distinctly prefer one tune to 
another, and perhaps know it by name. In other in- 
stances, however, the power to recognize a tune does 
not come until later childhood, and sometimes never. 
Things are made up to the baby later in life, for a 
child of ten years both sees and hears better than an 
adult. 

It would be interesting to know what a baby's sensa- 
tions are in its early months of life, but we can discover 
these only to a limited degree. It probably feels 
pretty comfortable, on the whole, and when uncom- 
fortable it cries. It experiences hunger and the inclina- 
tion to sleep. By the time it is a month old it often 



50 THE CARE OF THE BABY. 

shows its pleasure by smiling, but it generally does not 
really laugli until five or six months of age, or even 
older. Smiles before the age of one month are usually 
not indicative of pleasure, but belong to the class of 
automatic and similar movements referred to. 

The child clearly begins to have more intelligence, and 
the pleasure that accompanies this, when it is three months 
old, and by this time shows distinct evidence of having a 
mind and of exercising some thought. By this age or a 
little later it learns to recognize its mother and to be pleased 
at her approach, and if hungry will cease crying when it 
sees her preparing to nurse it. It also enjoys bright 
objects, especially if they are moving before it. Between 
three and four months of age it begins to look about it 
more, to feel the pleasure of grasping after objects, and to 
show fear and wonder. When it is four or five months old 
it learns to recognize other friends and to smile and move 
its arms at them. When nine months old it will give 
its hand when requested, and will thoroughly enjoy a 
game of "peep-bo." By the completion of its first 
year it has learned to show distinctly, by expressions 
of face and by gestures, its likes and dislikes for the per- 
sons and acts of others. Between the age of one and two 
years the baby shows some idea of number. 

All sounds made early in life are impulsive only. 
Although the child at one or two months of age begins 
to use its voice in making peculiar cooing noises expres- 
sive of comfort and happiness, it does not, of course, ivill 
to utter these particular sounds rather than others. About 
the age of six months the baby commences to make 
different vowel sounds, especially that of <?//, and a little 
later it learns to prefix these with such consonants as 
m^ b^ d^ p^ 11^ andy, these "being the easiest ones to pro- 
nounce. The mother often now firmly believes that the 



THE BABY'S GROWTH. 51 

baby means herself when it makes the sonnd of }}ia-j)ia^ 
bnt this is not the case. The child is only expressing 
some pleasurable emotion in this way. 

But with growing mental power the distinct imitation 
of sounds soon conies. By the age of eight or ten months 
the child utters several syllables intelligently, and when 
it is a year old it can say ''papa" and "mamma/' and 
maybe some other words, and really means what it says. 
Very often it acquires the understanding of certain words 
l)cfore it learns to speak even in syllables. At eighteen 
months of age it can express many of its desires by the 
use of a few words aided by gestures, and by two years it 
can speak in short sentences, although its vocabulary is, 
of course, very limited. 

We can, perhaps, best consider here the growth of con- 
trol over some of the functions of the body — namely, the 
movements of the bowels and the passage of urine. A 
great deal will depend upon the training, but all children 
liould gain complete control by the age of two years as 
an extreme limit, and most of them acquire it long before 
this, and need a diaper only during the night, if at all. 
Some who have been carefully taught have gained almost 
complete control as early as three months of age. 

We have yet to study the baby's growth in bodily pro- 
portions. There have been very many estimates made of 
the average height and weight of children at different 
ages, and there has even been constructed an elab- 
orate algebraic formula for calculating what these should 
be. The truth of the matter is that the variation is 
too considerable to allow of any iron-bound statements 
regarding it. The table here given (page 52) is an 
approximation of the length and weight which chil- 
dren should exhibit from birth up to sixteen years of 



52 



THE CARE OF THE BABY. 



Tabi,e Showing Growth in Height and Weight. 



Birth 19 in. 7 

1 week 7 

2 weeks 7 



lbs. 



3 

1 month 

2 months 
3 
4 

5 

6 

7 
8 

9 
10 
II 

1 3'ear 

2 3ears 

3 " 



5 
6 

7 
8 

9 
10 
II 
12 
13 
14 
15 
16 



20>^ in. 

21 " 

22 " 

23 " 



24 
25 

25>^ 

26 

27 
31 

35 



41 
43 
45 
47 
49 
51 
53 
55 
57 
59 
61 

63 



8 

8^ 
10^ 
12X 
13X 
15 

i6>( 
17X 

18^ 
19^ 

20>^ 

21K 
27 
32 
36 

40 

44 
48 

53 
58 
64 
70 

79 

88 
100 
109 

117 



9 oz. 

7>^ " 

io>^ " ^ 

2 " 



]] 



}• 



}• 



J 



I Gained i oz. a day; 7 
I a week. 



(Gained ^ oz. a daj^; 5>^ 
( oz. a week. 

Double original weight. 
f Gained ^ oz. a day; 4^ 
I oz. a week. 

. Gained yi inch a month. 
. Gainedaboutilb. amonth. 

. Treble original weight. 
. Gained 4 inches a jear. 

. Double original length. 
Gained 3 inches and 4 lbs. 
a 3'ear. 
f Gained 2 inches and 4 lbs. 
1 a 3-ear. 

f Gained 2 inches and 5 lbs. 
1 a 3'ear. 

f Gained 2 inches and 6 lbs. 
1 a 3'ear. 

Gained 2 inches and about 
9 lbs. a 3'ear. 



lyooking closely at the table, we notice several inter- 
esting facts. We see that the baby usually loses weight 
during the first week and often longer, but that by the 
end of two weeks it weighs distinctly more than at birth. 



THE BABY'S GROWTH. 53 

The loss of weight is greater than the table shows, for by 
the age of one week the baby has regained most of the 
loss. To this rule there are many exceptions, since chil- 
dren sometimes grow steadil\' heavier from the beginning. 
During the last tliree weeks of the first month the baby 
gains about one ounce a day; in the second month about 
one ounce a day; and in the third and fourth months 
about five ounces a week; that is, about three-quarters 
of an ounce a day. By the time it is five montlis old it 
has doubled its original weight. In the fifth and sixth 
months it increases two-thirds of an ounce a day, and 
after this, from seven to twelve months, it gains at the 
rate of about one pound a month — that is, three and two- 
thirds ounces a week, or a trifle over half an ounce a day 
— except in the ninth, and again in the eleventh month, 
when the increase in weight often lessens somewliat. 
At the age of a year the baby has trebled its original 
weight. 

As to length, we are struck by the fact that from the 
age of two to that of four months the increase is one 
inch a month, and after this, up to one year, it is half 
an inch a month. 

After the first year we notice that, taking it all together, 
there is a gradual increase in the number of pounds and 
a decrease in the number of inches added yearly, four 
inches being gained in both the second and third years, 
three inches in the fourth and fifth years, and after this 
two inches a year. The gain in weight is four pounds 
yearly from the age of three to that of seven years, then 
five, then six, and then about nine pounds. It sometimes 
happens that at about the age of nine in girls and eleven 
in boys there is almost a cessation of growth for a short 
time. Later, at about twelve years, girls take on a par- 
ticularly rapid growth, and decidedly exceed boys of the 



54 THE CARE OF THE BABY. 

same age in weight, although not in height. At fifteen 
or sixteen years the rapidity of growth in girls, both in 
weight and height, will be greatly diminished, while 
boys of this age will often begin to develop very rapidh', 
and will soon m.aterially exceed the other sex in both 
respects. These times for the retardation and accelera- 
tion of growth vary greatly, however, in different chil- 
dren. No fixed rule can be formulated. 

The weights and measurements in the table apply 
fairly well to children of both sexes, although it is a fact 
that boys at birth are apt to be somewhat larger and 
heavier than girls, and to continue so until the neighbor- 
hood of twelve years. In fact, all the figures in the table 
are, of course, only average ones, and a child may meas- 
ure or weigh somewhat less without there being any 
occasion for anxiety if it is perfectly healthy; while it 
may decidedly exceed the figures without being phenom- 
enal. This is especially true of children who have 
passed the age of three or four years. We all know how 
great the variations in size are in early and later child- 
hood. When, however, it is an infant which is materially 
behind in its height or weight, the mother should at 
least have her suspicion aroused that something is wrong. 
A useful and convenient plan of recording the weight 
during the first two years is upon a "Weight Chart," ^ 
such as the sample copy opposite. This is rather more 
accurate than the table. The figures at the top and bot- 
tom give the weeks and months of the age; those at 
the sides the pounds and ounces; each horizontal line 
representing four ounces. The line running diagonally 
across the chart represents the normal weight of an aver- 
age breast-fed baby. In using the chart the baby should 
be weighed weekly, a dot with ink made on or between 

1 These charts in blocks of twenty-five ccm be obtained from the publisher 
of this book for 50 cents. 



THE BABY'S GROWTH. 



55 



the horizontal lines to correspond with the weight ob- 
tained, and these dots as made joined by an ink line. 

This weekly weighing of the baby is exceedingly im- 
portant in order to be sure that growth is going on prop- 
erly. But to obtain results at all accurate it is very im- 
portant that the baby be weighed without clothes, or, 
better still, that it be weighed when dressed, and that 
the weight of the clothes or of a similar suit be ascer- 
tained afterward and 
the amount deducted. 
It will not, of course, 
be necessary to weigh 
the clothes separately 
on every occasion if 
we are careful that 
they are always of the 
same sort. Systematic 
weighing is particu- 
larly important when 
some change in diet 
is being made, for we 
can determine in this 

, ,, ,, r , Fu;. 6. — 1 he " 1 avorite " baby scales. 

way whether tlie food 

is sufficiently nourishing in quality or great enough in quan- 
tity. Either accurate spring scales or steelyards serve to 
do the weighing. A very convenient form obtainable at 
many of the shops consists of strong spring scales with a 
basket firmly attached, as shown in the illustration (Fig. 6). 
In using the steelyard the child is pinned securely in a 
towel or opened diaper and this then hung on the hook. 
In weighing children of five years and older the clothes 
may be assumed roughly to be one-twelfth of the total 
weight of the-child when dressed. 

To measure the length, the baby may be held against 
the wall with its feet resting upon the floor, and the 




,B 



56 THE CARE OF THE BABY. 

height be marked above it. A much more 
convenient and correct method is to have a 
carpenter construct an apparatus like an 
enlarged foot-measure of the kind em- 
ployed by shoemakers. This is used when 
the child is lying on a firm bed, the end- 
p I piece being placed above its head and the 

sliding one moved along until the feet (both 
toes and heels) rest upon it. The apparatus 
shown in the illustration (Fig. 7) is forty-six 
inches long, and the upright pieces are eigllt 
inches in length and are lined with felt. 

As the baby grows, not only is there an 
increase in the total weight and height, 
but the relative value which the dimen- 
sions of the various parts of the body bear 
to each other also changes, since one part 
grows more rapidly than another. This is 
well shown by the accompanying illustra- 
tion, taken from an article by Dr. L. M. 
Yale^ (I^ig- 8). The six figures represent 
the ages of one, five, nine, thirteen, seven- 
teen, and twenty-two years; that is, they are 
separated by periods of four years each. 
Each figure is divided into four equal parts, 
marked by the crossing of the dotted lines. 
The lines are curved, simply because the 
child grows more and more slowh\ If its 
length kept increasing at the same rate all 
the time, it is obvious that the lines would 
be straight. If we look again at the dia- 
FiG. 7.— Appa- fe^^"^) we see that the head of the child of 
ratus for measur- one \'ear mcasurcs one-fourth of its total 

ing an infant s 

length. ^ Babyhood, vol. ii. p. 31 1. 



11 




THE BABY'S GROWTH. 



57 



length, while the trunk is not much more than this, and 
the legs do not measure more than one and one-half 
fourths (three-eighths). As the author says, the child 




1 

Fig. 8. 



5 © 13 17 21 

-Diagram showing pro|X)rtionate growth of diflerent parts of the body at 
various ages from l to 2I years. 



is "four heads high.^' In the adult of twenty-one 
years we see th^t the head is proportionately much 
smaller, measuring only two-thirteenths or less of the 
whole length, while the legs have grown much more 
rapidly, and now equal one-half of the total length. The 
trunk has not kept pace with the legs, for in the baby 
the middle of the body, as shown by the dotted line, is 
the navel, while in the adult it is decidedly lower. All 
this rapid growth of the legs is generally accomplished 
after the age of nine years, as the diagram shows. It is 
well known how rapidly boys and girls shoot up after 
this period, and how out of all proportion their appa- 
rently long legs seem. The legs are, in fact, really no 
longer than they ought to be, but we have grown so 
accustomed to the short legs of earlier years that the 
change does not seem natural. 



58 THE CARE OF THE BABY. 

At the age of thirteen or fourteen years, the time of 
puberty, a decided change takes place in girls, the figure 
beginning to assume that of womanhood, and the men- 
strual discharge appearing; while at about the same time 
or a little later boys experience a change of voice. 

Besides the growth in height and weight, there is, of 
course, increase in girth as well. The matter of most 
importance here is the circumference of the head and 
that of the chest. We should know what these ought to 
be at different ages, for the proper increase of girth of 
chest is an indication of proper development, and varia- 
tions from the normal size of the head may indicate dis- 
ease. It is important, however, to remember that the 
heads of different babies vary much in shape and size 
within normal limits. The chest-measure should be 
taken just above the nipples, and that of the head at a 
little above the level of the eyebrows. The following 
table shows approximately the circumferences of the chest 
and of the head at different periods of life: 

Table Showing Circumferences of Head and Chest at 
Different Ages. 

HEAD. CHEST. 

Birth 1334 inches. 13 inches. 

6 months 1634^ " 15^ " 

1 year 18 " 17 " 

2 years . . . , i8>^ " 1734' 

3 " 19 " 19.^4^ " 



6 " 1(^)4. " 2034^ 

12 " 20 " 23;^^ 

Adult life 21;^ " 30 + 



It is interesting to observe from this table how much 
more rapidly the chest grows than the head. 

In this connection we must not forget the condition 
of the anterior fontanelle. This opening should become 



THE BABY'S CKoirTH. 59 

steadily although slowly smaller by the growth of bone 
over it, and should be entirely closed in healthy children 
by the age of seventeen or eighteen months. 

Finally, we must consider some of the new acquisitions 
of the child in the line of development. Among these is 
the ability to shed tears, which has already been referred 
to. A new-born baby can cry and its eyes become 
moist, but it is generally not until the age of three or 
four months that tears actually run down its face. 

Another acquirement is tlie new head of hair which fol- 
lows the first one. At about the end of the first week the 
first hair often begins to fall out, and continues to do so 
for one or two weeks. A considerable amount of it also 
is worn away from the back of the head by friction 
upon the pillow. The new hair begins to grow in only 
ver>^ slowly, and is of the same soft, silky texture as the 
first, but lighter in color than it was, or than the hair 
will be in adult life. Indeed, throughout the child's life, 
leaving the first hair out of account, there is a tendency 
for the color to grow constantly darker. The speed with 
which the hair grows in is very variable. One may some- 
times see a child of five months with its head actually 
shaggy, but as a rule it is very thinly covered at this age 
and for mouths after it. Sometimes children are born 
with remarkablv shaggv heads of hair and do not suiTer 
this early loss of it. 

Then, too, the baby acquires increased powers of diges- 
tion not possessed before. Saliva is one of the secretions 
of value in the digestion of starch. In early life it is 
only sufficient in amount to keep the mouth moist, but 
at the age of three or four months it has increased so 
greatly that the baby begins to dribble and must have its 
clothing protected by a bib. ^lany people suppose that 
this dribbling is a sign of irritation produced by the cut- 



60 THE CARE C^" THE BABY. 

ting of teeth, but, although it usually accompanies 
teething, it is really only the evidence of the acquisition 
by the child of the new secretion. Indeed, there is no 
excessive production of saliva at the time the teeth which 
are the hardest to cut — namely, the molars — come through 
the gums. There is certainly no intimate connection 
between healthy dentition and the flow of saliva. 

So, too, the secretion of the stomach, generally called 
the gastric juice, is very poorly developed in young 
babies, and the digestive strength of the juices of the 
pancreas and of the intestine is also very weak; but all 
these increase with advancing age. On the other hand, 
the movements of the stomach are remarkably active in 
babies, and we consequently often see regurgitation of 
food occurring daily. 

Finally, we have the acquisition which is the cause of 
the greatest excitement and pleasure to the family at first, 
and often of much worry later — the teeth. At the very 
outset we must bear in mind that teething is a normal 
process, and not a disease. We are making a woful mis- 
take if we attribute to teething disturbances of the baby 
which are caused by some real ailment. Many and many 
a mother has allowed a child to suffer, and even to die, 
because she has supposed that the evident distress was 
the result of an advancing tooth. It is one of the com- 
monest things in the world for a tooth to be cut without 
anyone knowing that anything is happening. It is never 
right for a mother to take it for granted that the teeth 
are the source of fretfulness, but a thorough search must 
be made for some more remote cause. Physicians sel- 
dom practise gum-lancing nowadays, as compared with 
the frequency of a few years ago. There is, however, 
such a thing as disordered dentition, but this can be 
better considered among the diseases of infancy. 



THE BABY'S GROWTH. 



6l 



A baby at birth possesses smooth, firm gums, of a light- 
pink color, with quite uarrow and rather sharp and hard 
edges. After some months, as the teeth begin to ap- 
proach the surface, the edges of the gums grow broader 
on the anterior aspect and somewhat more prominent, 
but do not become red or inflamed in ordinary healthy 
teething. This condition may continue for a month or 
more before any teeth are cut. The teeth have a definite 
order of appearing; and yet this is subject to very great 
variation, and writers differ somewhat as to just what the 
normal order is. There are twenty milk teeth — tempo- 
rary or deciduous teeth, as they are also called — and 
b their eruption constitutes the 

first dentition. They consist, in 
each jaw, of two central incis- 
ors, two lateral incisors, two 
canines, two anterior molars, 
\,Nu^ ,. ' T, ' and two posterior molars. Their 

Fig. 9.— Di.igram showing ihe arrangement may be seen in the 

temporaiy teeth : a, central in- diagram (Fig. o). The CauiuC 
cisors; />, lateral nicisors; i\ ca- _ , . 

nines; r/, anterior molars ; e, ik)s. tCCtll of the UppCr jaW are COUl- 

terior molars. ,^^,^1^, ^,^|1^^ ^j^^ ^^^ ^^^^1^^ ^^^ 

those of the lower jaw the stomach teeth. 

The pcrma)icut teeth, or the teeth of the second 
dentition, number thirty-two. They begin to appear 
about the sixth year of life, and consist of four incisors, 
two canines, four bicuspids, and six molars in each jaw 
(Fig. lo). In this dentition the incisors and canines 
replace those of the first dentition, the bicuspids 
take the place of the temporary molars, and the perma- 
nent molars appear where there were no teeth at all 
before. 

The teeth are cut in distinct groups, with a pause be- 
tween the eruption of each group. This arrangement 




62 THE CARE OF THE BABY. 

gives the child a rest from any irritation that may 
attend the process. 

The first group of the milk teeth to appear usually 
consists of the lower central incisors, which come through 
the gum at about the age of seven months, although 




Fig. io. — Diagram showing the permanent teeth: a, central incisors; b^ 
lateral incisors; c, canines; d, first bicuspids; e, second bicuspids; f, first 
molars; g, second molars; //, third molars. 

often earlier than this. Then occurs a pause of three to 
eight weeks, followed by the appearance of the second 
group, consisting of the four upper incisors, between the 
age of eight and ten months. The central upper incisors 
generally appear first, followed closely by the lateral 
upper incisors. A second pause now occurs, lasting from 
one to three weeks, followed b}' the eruption of the third 
group of teeth — namely, the four anterior molars and the 
two lower lateral incisors — which appear at the age of 
from tw^elve to fifteen months. The teeth of the third 
group are not all cut at once or in any invariable order, 
although the anterior molars in the upper jaw often come 
first, and are followed by the incisors and then by the 
molars of the low^er jaw. After the third group there 
comes a pause of two or three months, no more teeth ap- 
pearing until the age of eighteen months, at which time, 



THE BABY'S GROWTH. 6^ 

or between the ages of eighteen and twenty-four months, 
the fourth group, the canines, are cut. Finally, after 
another pause of two to four months, the fifth group, 
the posterior molars, appear, between the twentieth and 
thirtieth months of life. Thus it will be seen that a 
baby a year old should have at least six teeth, and pos- 
sibly twelve, if the third group is cut promptly, and that 
by the time it is two or two and one-half years of age all 
the temporary teeth should be through. The following 
tabular arrangement shows at a glance the order and 
time of the eruption of the temporary teeth: 

KuuPTioN OK Milk Tketh. 

First grou]) . . Two lower central incisors. . 7 nionlhs. 

Pause . . . . 3 to 8 weeks. 
Secoiul group . . 1^'oiir upper incisors i<» n> 

Pause . . . . I to 3 months. 
Third group . . Four aiUerior molars and two 

lower hiteral incisors ... 12 to 15 

Pause . . . . 2 to 3 months. 
Fourth grouj) , . F'our canines 'S lo 24 

Pause . . . . 2 to 4 months. 
Fifth group . . Four posterior molars . . . ju to 30 

As has already been stated, a great deal of variation is 
seen both in the order and in the time of the cutting of 
the milk teeth, and the mother need not think it strange 
if the two lower central incisors are not the first to 
appear. So, too, a healthy baby may cut its first tooth 
at decidedly less than four months of age, or may even 
be born with some incisor teeth; or, on the other hand, 
may still be toothless at the age of eight or nine months. 
Instances of children born with teeth are uncommon. 
Such teeth generally soon fall out and are replaced at the 
proper age by the regular milk teeth. Sometimes, how- 
ever, they remain until supplanted by the teeth of the 



64 THE CARE OF THE BABY. 

second dentition. It is at times necessary to remove 
these premature teeth, but the decision upon this point 
will naturally be left to the child's physician. 

Too great a delay in the beginning of dentition is a 
sign of ill-health, and a baby who has no teeth by the 
age of a year cannot be considered to be in a healthy 
state, however plump and well nourished it may bCc 
Just what ails it we shall consider in the chapter treat- 
ing of the Sick Baby. 

The milk teeth stay in position for several years. 
Then, as the permanent teeth push upward in the jaw 
beneath them, their roots become partially or entirely 
absorbed, and the teeth themselves loosen and fall out, or 
are pushed out by the advancing pennanent teeth, in 
much the same order as that in which they came in. 
Very often they do not fall out as soon as they should, 
and, as a result, the incoming second teeth are crowded 
out of position, and a very ugly displacement is finally 
produced, which is wholly the result of negligence on 
the part of the mother. A child should be taken to the 
dentist at regular intervals, whether or not the teeth are 
decayed, in order that no such disfigurement may arise; 
for it is much easier to prevent it than it is to correct it 
when once present. The narrowness of the jaw in a child 
is another reason why the permanent teeth, particularly the 
canines, are so often displaced forward and outw^ard, and this 
fact renders the advice of a dentist still more important. 

The earliest of the permanent set to appear are the 
first anterior molars, often called the "six-year-old teeth," 
which come in immediately adjoining and to the outside 
of the temporary second molars. The remaining per- 
manent teeth are cut in much the same order as the milk 
teeth. The order and the date of appearing are shown 
in the following table: 



THE BABY'S GROWTH. 65 

Erui*tion of Permanent Teeth. 

Four first molars 6 years. 

Four central incisors . . . .7 " 

Four lateral incisors . . . . 8 " 

Four first bicuspids . . . 9 to 10 " 

Four second bicuspids . 10 to 11 " 

Four canines . 11 to 13 ** 

Four second molars 12 to 15 '* 

Four third molars 171025 

The teeth of the lower jaw are cut somewhat belbre 
the corresponding ones of the upper jaw, the intervals 
bein<^, perhaps, as great as several niouflis. The time 
of the eruption of the pennanent teeth varies consider- 
ably within certain limits. The third molars are popu- 
larly termed the ''wisdom teeth.'* Their eruption is 
frequently delayed until considerably after the age of 
twenty-five years. 

The alterations in pulse and respiration and in the fre- 
(piency of the bowel-movements and of the passage of 
urine which take place with increasing age, as well as 
some of the minor changes of the first few weeks, have 
already been referred to at length in the preceding chap- 
ter. This was done as a matter of convenience merely, 
for the changes are connected closely with the baby's 
growth, and belong properly to the subject of the present 
chapter. 

Finally, let no mother conclude oflfhand that the statis- 
tics which have been given are incorrect because they do 
not accord with her experience in the case of her own 
children. They are average only, and are the result of 
much and careful study by different observers. Of course, 
some children are much ahead of the average, and others 
behind it, vet they are nevertheless neither remarkable 
nor unhealthy. 



66 



THE CARE OF THE BABY. 



CHAPTER IV. 

THE BABY'S TOILET. 

All this time, although we have been watching the 
baby grow, we have not seen it either bathed or dressed. 
In preparation for the first and for subsequent toilets it is 
customary, before the baby's birth, to get ready that most 




Fig. II.— Baby's basket. 

convenient article commonly known as the baby^s bas- 
ket. A large selection of baskets may be found in the 
shops, fitted in different ways to suit the varying fancies 
and means of mothers. In choosinof one it is to be 
remembered that too elaborate a basket is more orna- 
mental than useful. A serviceable form is a stand of 



THK BABY'S TOILET. 



(>7 



wicker, the lower part of which consists of one or more 
shelves or of a closed basket where articles of clothing 
not immediately needed can be kept; while the upper 
portion, or baby's basket proper, consists of an oval or 
oblong, rather shallow receptacle which may or may not 
be provided with a lid (Fig. ii). It is important that 
the stand be low, as otherwise the articles contained can- 




Fin. 12. — Baby's bxsket, hani{>er forn 



not well be reached from the low chair used when mak- 
ing the child's toilet. The basket should possess several 
pockets around the inside, to hold the smaller articles. 
It should also have one or two pin-cushions fastened 
within it. The interior may be lined with silk or cam- 
bric, according to taste, and the basket draped with lace 
or Swiss muslin. 

A simpler and very popular kind of basket, more easily 



68 THE CARE OF THE BABY. 

moved about, is one of the hamper form with a hinged 
lid. This is, of course, not provided with a stand. The 
lower part of the hamper contains clothing, while a tray 
above this holds the various articles for immediate use 

(Fig. 12). 

The baby's basket should contain the following 
articles: 

Salicylated cotton for dressing the cord. 

Plain absorbent cotton for washing the mouth and eyes. 

Blunt-pointed scissors. 

Safety-pins of assorted sizes. 

A soft baby's-hair-brush. 

A small, fine comb. 

Powder-box containing powder and puff. 

Soap in a metal or celluloid soap-box. 

A fine, soft sponge and a soft wash-rag. 

A jar of vaseline. 

An old soft blanket in which to receive the child after 

birth. 
A couple of soft towels. 
A woollen shawl or shoulder-blanket. 
A complete suit of clothes. 

The choice of the soap, powder, hair-brush, etc. will 
be considered presently, and the nature of the clothes 
will be discussed in the next chapter. 

The first washing of the baby is the business of the 
monthly nurse, and the mother has no share in it. Still, 
it is well for her to understand how it should be done, if 
only as a matter of interest. We must remember that 
the new-born baby is a very tender object, exceed- 
ingly susceptible to the influence of cold, and with a ver>^ 
delicate skin. Indeed, in the case of children weakly at 
birth the physician often forbids any washing whatever 



THE BABY'S TOILET. 69 

until the vitality has increased. In giving a bath it is 
consequently necessary to guard most carefully against 
draughts. The doors and windows must be closed, and 
the child should be protected still further by placing a 
folding screen around the nurse's chair and the tub, and 
by doing the bathing before a fire unless the weather be 
very hot. 

The washing and dr>'ing should be done thoroughly, 
rapidly, and yet with the greatest gentleness. The nurse 
seats herself in her low chair beside the tub, with the 
baby's basket and the vessels of hot and cold water con- 
veniently at hand. She should protect herself with a 
rubber apron, over which is a second bath-apron of 
warmed soft flannel. A very convenient form which has 
been recommended consists of two long and broad pieces 
of flannel or other soft material sewed or, better, buttoned 
to the same waistband. The lower one of these may be 
used to hold the baby in, and the upper one to cover it 
after its daily bath and while it is being dried with the 
towels; or the upper one may hold the baby while being 
dried, after which it may Ije unbuttoned and cast aside, 
and the lower, dry apron may be used to hold the child 
while being dressed. At the first washing the old blan- 
ket contained in the baby's basket should be used to 
wrap the child in immediately after birth and until it 
has been oiled, soaped, and dip|:>ed. 

The new-born baby is more or less covered with a 
whitish, waxy substance which must be removed en- 
tirely, especially from all folds and hollows of the body, 
such as the armpits, hollows of the knees, groins, and 
ears, as otherwise irritation of the skin is apt to be 
set up. As the cleansing is not easily accomplished by 
ordinary washing, it is necessary first to rub the skin all 
over with olive oil or with purified white vaseline. This 



yo THE CARE OF THE BABY. 

is much better than lard unless the latter has been care- 
fully freed from salt by washing. The baby should now 
be laid on its back and be enveloped in the old blanket, 
and should then have its face carefully washed with 
warm water and a very soft sponge or wash-rag, but 
without soap. The eyes must receive particular atten- 
tion. The lids should be separated by the fingers and 
gently and thoroughly freed from all secretions by squeez- 
ing a little warm water between them and very geutly 
rubbing them with a little moistened absorbent cotton. 
This care is needed, because in the process of birth irri- 
tating substances often enter the eyes and set up a severe 
inflammation which may even terminate in loss of sight. 
Sometimes the physician in charge himself washes the 
eyes, or orders them to be washed with some antiseptic 
solution if he deems it necessary, but such solutions 
should never be used without his orders. 

The mouth must now be cleansed very carefully with 
a little absorbent cotton wrapped around the nurse's 
finger. Indeed, it is often necessary to wash the mouth 
instantly after birth if much mucus or other material has 
been forced into it. 

The bath may now be prepared, the water being at a 
temperature of ioo° F. as shown by the thermometer, 
not as guessed at b}^ the nurse. The whole body except 
the face, which has already been washed, is now rubbed 
with soap and water. The soap is best applied with 
a wash-rag, which adapts itself to the folds and creases 
rather better than a sponge does. The baby is then 
placed in its tub and entirely submerged except the 
head. It may be kept in the bath for a minute or two 
if it seems to enjoy it. While there its head and 
back are supported by the nurse's left arm and wrist, her 
hand grasping its left shoulder, and thus keeping it from 



THE BABY'S TOILET. 7 1 

slipping down into the water. When the bath is over 
the child is lifted into the nnrse's flannel apron, covered 
well, and made to lie first on its back and then on its 
stomach while it \^ patted thoronghly dry with the softest 
towels. As a finishing tonch a little powder is dusted 
about the folds and hollows of the body and the baby is 
then ready to be dressed. 

Succeeding baths are much like this first one, with the 
exception of the oiling. Many physicians advise only a 
daily sponging until the cord has separated, and after 
this the tub-bathing. There are certain modifications in 
the bath, however, which depend upon the age of the 
child, and these, with some details regarding other mat- 
ters connected with the toilet, niHst be considered a little 
more particularly. 

The nature of the baby's bath-tub is of some import- 
ance. I*()r the first bath a ])aiiitt(l tin foot-tub, or even 




Fic. 13. — Folding bath-stand. 



a large basin, will answer, but it is well to be pro- 
vided in advance with a tub especially designed for a 
baby^s use. There are many varieties of these. A ser- 
viceable one for constant employment is of tin, porce- 
lain, or agate iron, oval in shape, and with a sloping 
back. Wooden and papier-mache tubs are difficult to 
keep clean. As leaning over such a tub while giving the 
bath is a very back-breaking procedure, it is desirable to 



72 



THE CARE OF THE BABY. 



place it upon a low stand, eighteen or more inches high, 
made for the purpose. Stands of this sort may be bought 
in the shops. They are either of permanent form or of 
such a nature that they can be folded up and put away 
when not in use (Fig. 13). 




Fig, 14. — Bath-tub on slats. 

A very convenient device has been described, intended 
to obviate stooping and to render the filling and empty- 
ing of the tub easier (Fig. 14). A couple of strong slats 




Fig. 15. — Home-made rubber bath-tub. 

several inches wide, with cleats on the under surface to 
prevent slipping, are placed across the ordinary station- 
ary bath-tub when needed. Upon these the baby's bath- 
tub rests, and may be filled by means of a rubber hose 



THE BABY'S TOILET. 73 

screwed to the faucets. It is a good plan to attach the 
tub to tlie slats by straps when in use, in order to pre- 
vent the possibility of pushing it off. 

A still more convenient tub made of rubber can be 
bought. It is of a folding pattern, which does away 
entirely with the stand. It occupies very little space 
when not in use, and is especially serviceable to take 
to summer resorts or when visiting. It may even serve 
as the baby*s bed. An inexj^ensive home-made rubber 
tub is shown in the illustration (Fig. 15). The legs, 
each of which is thirty inches long, are pivoted upon 
the ends of the central bar. This and the four side- 
bars are each thirty-six inches in length. The latter 
are fastened firmly to the legs. The tub itself is 
made of a single piece of white rubber cloth thirty 
inches wide and one and a quarter yards long. There 
is a hem at each end, and through these hems 
broad tapes, each nineteen inches long, are passed and 
securely fastened to the ends of the side-bars. The 
sides of the rubber cloth 

are tacked to the top of ^^:^^^^^ /^'^^^^^^P^^^^^^^^^^^^ 
the side-bars. A .small (v^ j^ I j) 

plait at each corner gives ^^fc:;^.^^^ I -^^:^^^ 

the tub a better shape. ><:. ^_^ 

A little ingenuity can ^' ^.^,^^^. _ ^ ^^^ ^ 

easilv make the legs de- 

, ' - - - , Flc. iC— (.hinn M ., 

tachable from the central 

and side bars and from each other, and thus allow of 

packing the tub into very small space for travelling. 

An outfit for bathing is not complete without a rubber 
cloth or an oil-cloth to be laid beneath the tub to protect 
the floor, and the low chair with a broad seat upon which 
the nurse is to sit, and to which reference has already 
been made. One of the small china sponge-basins made 



74 THE CARE OF THE BABY. 

especially for the baby's toilet is also very serviceable. 
It is divided into two compartments — one for cold and one 
for warm water (Fig. i6). 

After the child has reached the age of two or three 
years a second and somewhat larger tub may be bought. 
This is not an absolute necessity, as the ordinary station- 
ary bath-tub can be used instead. It is, however, a great 
convenience, and saves the uncomfortable leanjng over 
which is necessary with the latter. 

In this connection it is important to understand fully 
the value of early accustoming a baby to immersion in 
water. I have frequently seen the great fear of the tub 
bath, shown by children who had been accustomed to 
sponging only, interfere with the use of cool bathing in 
cases of fever and of exhaustion by summer heat, at times 
when it would have been of the greatest remedial value. 
Moreover, it is wellnigh impossible to attain by spong- 
ing alone, no matter how thoroughly done, the cleanli- 
ness which tub-bathing ensures. 

To prevent the fear of the bath developing, we should 
carefully avoid any sudden or rough plunging of the child 
into the water, and especially see that the head does not 
accidentally become submerged. Fear which has been 
acquired in any way may sometimes be overcome by cov- 
ering the tub with a blanket, placing the baby in this, 
and gradually lowering baby and blanket into the water; 
or the child may be put into the empty tub and 
allowed to play there until it is quite at home, and may 
then be accustomed to an amount of \vater which is 
increased a very little day by day. 

A wash-rag made of flannel or of diaper-cloth should 
be used for applying soap. A delightfully soft wash-rag 
is made of cotton stockinet. All the folds and hollows of 
the body must be soaped thoroughly, but no eftbrt should 
ever be made to force the fingers or anything else into the 



THE BABY'S TOILET. 75 

ears, and no water should be allowed to remain there. 
Severe inflammation of the ears has often followed over- 
zealous attempts at cleansing. 

The scalp should be soaped daily during some months. 
After the age of six months, however, it is not advisable 
to do this quite so frequently, as it renders the hair dry 
and brittle. This does not mean that soaping of the head 
is to be neglected entirely. The application occasionally 
of a very little vaseline may be of l^enefit. As the infant 
grows into childhood the scalp should be washed with 
soap once or twice a week at least, and with water daily. 
Ivven the long hair of the girl need not prevent this. 

The importance of daily retracting the foreskin of boy 
babies, and of washing carefully beneath it, must not be 
forgotten (see Phimosis). 

For removing the soap-suds a sponge is better than a 
wash-rag, since it permits of the water being squeezed 
from it in a distinct stream. Only the finest sponges 
should be chosen, from which the minute flinty particles 
have been entirely removed in the process of prepara- 
tion. These little needle-like bodies are present in many 
of the cheaper sponges, and are very irritating to the skin 
even of an adult. The sponge and the wash-rag should 
be well washed out and be thoroughly dried in the air 
after each bath and before being used again. If this is 
done, there is no objection to their being kept in the rubber 
pockets with which the baby's basket is often furnished. 

In the choice of soap there is a wide range. It is 
important to select one which is entirely unirritating and 
free from an excess of alkali. Transparent glycerin soap 
and oatmeal soap are good, but there are few equal to 
the well-known Castile soap. As there are different 
varieties of this, some of which are not at all suitable, it 
is important to choose one of the finest imported brands, 
certainly made of olive oil and got from a dealer of well- 



76 



THE CARE OF THE BABY. 



known reliability. Still better are some of the imported 
German " super- fatted " soaps. One of these, called in 
Germany a Basis Seife^ is intended especially for use 
with children. It is unirritating, and contains an un- 
usual amount of oil. It can be procured through drug- 
gists, and is probably the best soap for infant use w^hich 
is to be had at the present time. 

The water used for the bath should be soft and clear 
when it is possible to obtain it so. Very hard water will 
make the skin rough and sore. It ma}^ be improved by 
boiling, which precipitates much of the lime, but it is 
better to substitute rain-water. Muddy water must be 
filtered. This may be done through one of the various 
filters made to screw upon the faucet. A very service- 
able plan is to tie a bag of flannel over the 
opening of the faucet and to let the water 
run very gently through it. A fresh bag 
should be used every day. The temperature 
of the water is very important. Our hands 
are so made that they accommodate them- 
selves readily to degrees of heat or cold. 
They are consequently poor guides in deter- 
mining the actual temperature of the bath. 
The bared elbow dipped into the w^ater is 
much more sensitive; but if we do not wish 
to have the baby sometimes parboiled and 
sometimes frozen, it is far better to use a 
bath thermometer (Fig. 17). This may be 
had at any good house-furnishing store or 
drug-store. The casing is made of wood, in 
order that the instrument shall not sink in 
the water. To test the temperature of the 
Fig. 17.— Bath bath the thermometer should be moved back 
ermomeer. ^^^^ forth iu the water for a few minutes, 



THE BABY'S TOILET. yj 

and tlie height of the iiiercury noticed while the bulb is 
still in it. 

The temperature of the first bath should be 100° F., 
and that of succeeding ones be lowered very gradually 
until, at the age of six months, the water is at 90^ to 95° 
I\ for winter or at 80° to 85*^ F. for summer. Actually 
cool baths should not be given before the age of four or 
five years, although by two years a cool sponging may im- 
mediately follow the warmer bath, provided the bracing 
effect is produced wliich may reasonably be expected. 
(For the temperature of hot, warm, and cool baths, etc., 
see Api)endix, 36.) Whatever the temperature of the 
bath, it is important that the head and the face be wet 
before the rest of the body. 

Enough water .should be used in bathing to cover the 
baby to the neck when supported in a .semi-reclining 
position. As it grows older and learns to sit upright the 
water need not reach above the armpits. The duration 
of the immersion should at first be one or two minutes, 
and later about five minutes. One bath .should be given 
every day, but in very hot weather, when the baby is evi- 
dently depressed by the heat, several cool baths daily are 
sometimes very beneficial. In such cases they are given, of 
course, for their cooling effect, not for cleansing purposes. 

Besides the regular daily bath, it is important to 
sponge the lower parts of the body after each bowel- 
movement, in order to ensure perfect cleanliness. Simple 
warm water is usually sufficient for this, and soap should 
not be employed. Most careful drying must follow. In 
the early mouths of life an evening sponging of the whole 
body is often practised. It is frequently of advantage, 
but is not an essential. 

When the child has reached the age of four years the 
bathing may consist of cool sponging every morning 



78 THE CARE OF THE BABY. 

with water at a temperature of 75° to 80° F., the child 
perhaps standing in lukewarm water, but it is much 
better to continue the daily tub-bathing with water of 
80° to 90° F. Prolonged soaking in hot water is to be 
condemned as excessively relaxing and as predisposing to 
catarrhal conditions. During later childhood the tem- 
perature of the bath may be reduced to 75° or 80° F. 

In this connection the importance of following experi- 
ence rather than theory cannot be too strongly insisted 
upon in regard to using cold water. If a child invariably 
shivers and continues cold after tepid or cold baths — that 
is, if a proper "reaction" does not take place — it will 
certainly be injured by continuing them. One must be 
quite sure, however, before abandoning them, that there 
is not somethinof wronor about the method rather than 
about the baths themselves. Brief immersion and brisk 
friction afterward are all that are required to make the 
baths healthful and tonic for the majority of children. 

The time for bathing a child is not so much a matter 
of importance as it is that the bath shall be given at the 
same hour every day, and not too soon after eating. At 
least an hour should elapse after taking food. It is also 
better not to allow the child to go out of doors imme- 
diately after bathing, especially in cold weather. During 
the first two or three years of life a morning hour — 
either before breakfast or at about nine or ten o'clock — 
is to be preferred unless an evening hour be chosen for 
the sake of relieving sleeplessness by means of the bath. 
Later the daily bath is best given when the child rises 
in the morning. 

A fuller consideration of baths of different tempera- 
tures and of different sorts, particularly as used in dis- 
ease, will be found in the Appendix (36-50). 

The choice of towels is of some importance. Especially 
for young babies they should be of the softest and most 



1 



THE BABY'S TOILET. 79 

absorbent material. An old diaper constitutes one of the 
best of towels at this age, and later in life Turkish towel- 
ing, not new, is excellent. After the drying it is well 
to rub the baby briskly with the palm of the hand until 
its skin is slightly reddened, in order to establish a good 
circulation of the blood. Sometimes rubbing with warm 
alcohol or warm bathing whiskey or with a little olive 
oil is of distinct value for delicate children. 

Some difference of opinion exists regarding the advisa- 
bility of powdering the child after the bath. In theory, 
the drying should be so perfect that powder is not needed. 
In practice, however, it is difficult to obtain this perfect 
dryness, or to appreciate the failure until the production 
of chafing and fissures of the skin show^s that there has 
been a fault in this respect. It is therefore a useful plan, 
after using the towel as thoroughly as possible, to powder 
the folds of the skin, as around the neck, about the cars, 
in the armpits and groins, and behind the knees. The 
powder used should be of the simplest kind, such as 
finely-powdered starch or lycopodium, or, still better, 
talc. It is best to avoid the various scented powders on 
the market, since they may contain impurities. Some- 
times a little vaseline or cold cream may be applied with 
advantage instead of the powder. This is especially true 
if the creases in the skin appear to be somewhat too dry. 

We must consider briefly the subject of out-door bath- 
ing, and particularly of sea-baths. The action of salt 
water seems often to produce a peculiarly beneficial effect 
upon weakly children. Too much cannot be said against 
the exhibition of basest cruelty which may so often be 
seen — a father or mother carrying a screaming, terrified 
little one of tender age into the breakers. The exposure 
to the cold water and the action of the great fright can 
be nothing but very injurious. The only fit place for 



8o THE CARE OF THE BABY. 

infants to take a salt bath is the tub. There is no 
harm, however, in dressing a child of three years of age, 
or even younger, in bathing-clothes, protecting it from 
the sun by a bathing-hat of suitable size, and allowing it, 
on a calm, warm day, to paddle in the ripples on the sand 
or to play in the pools of sun-warmed water left by the 
receding tide. In this way the child's confidence in the 
harmlessness of the water is established, and at the same 
time the good effects of sea-bathing are gained without 
fright.- The mother must never forget to watch carefully 
against chilling by too long a wetting or by exposure to 
strong winds in moist clothes. 

Older children who have acquired a love for surf- bath- 
ing or fresh-water bathing would apparently remain in 
the water for ever if permitted to do so. The mother 
must enforce a limitation of the bath to ten minutes at 
the longest if the water is cool, or twenty to twenty-five 
minutes if warm. Chattering of the teeth and blueness 
of the lips are indications that the bath should cease, no 
matter how short it may have been. The after-effects 
are a still better guide in the matter. Exhaustion or 
lassitude during the rest of the day renders necessary a 
reduction of the length of the baths or of their fre- 
quency. Not every child can bear a daily out-door bath. 

In the case of sea-bathing it is important to guard 
against blows of the breakers against the ears, since 
injury to the drums may result. 

There are certain other matters connected with the 
toilet which can best be considered in this connection. 
Prominent among these is the washing of the mouth and 
teeth. Babies are much disposed to various fonns of 
inflammation of the mouth. It is necessary, therefore, 
that a toilet of the mouth be perfonned systematically, 
and yet it is just as important that this be done with the 



THE BABY'S TOILET. 8 1 

greatest care and gentleness, or there will be produced 
the very trouble which we are striving to prevent. 
Nurses often forget their own size and strength and 
roughly force a big finger into a delicate little mouth, 
thereby doing much more harm than good. To perform 
the toilet properly a little absorbent cotton should be 
wrapped around the little finger or around a smooth 
stick, taking care that the cotton project decidedly be- 
yond the end, and with this moistened in boiled luke- 
warm water and used gently the washing can be done 
very satisfactorily. It should be repeated three or four 
times a day, or, better still, after each feeding, of course 
using a fresh piece of cotton on each occasion. After 
the child begins to secrete saliva in abundance and to 
move the tongue freely it is unnecessary to wash the 
mouth so frequently. 

Mothers often think that it is a matter of no conse- 
quence if the milk teeth decay, since they will soon fall 
out in any case. This is far from the truth, for not only 
does their decay detract greatly from the child's good 
looks and become a fruitful source of toothache, but their 
imperfection or loss is a cause of indigestion from insuf- 
ficient mastication, and may even cause irregularity in 
the position of the permanent teeth. 

The washing of the mouth should be continued as the 
earliest teeth are cut, and the teeth themselves thoroughly 
rubbed with a moistened cloth morning and evening. 
After the majority of the milk teeth are through the 
gums, a small tooth-brush with soft bristles of badger- 
hair or specially softened pig-bristles is to be preferred. 
If any stains appear on the teeth, a little precipitated 
carbonate of lime in finely-powdered form may be used 
on the brush. If this does not prove successful in remov- 
ing the discoloration, a small pine stick, such as a match- 



82 THE CARE OF THE BABY. 

stick, may be sharpened into a chisel-shaped edge, moist- 
ened, dipped in finely-powdered pumice-stone, and rubbed 
upon the spots until they are removed. Care must be 
taken to avoid injuring the gums while using the stick. 
The collection of tartar upon the teeth is the commonest 
cause of inflammation and receding of the gums, and 
nothing but diligent watchfulness will prevent it. 

As early as possible the child should be taught itself to 
use the tooth-brush and powder twice daily, and to draw 
waxed floss silk between the teeth or to use a quill tooth- 
pick — in private — after each meal. Should decay take 
place, it is all-important to have the trouble corrected by 
a dentist. Indeed, it is best in any case to let the baby 
pay its first visit to him not later than the age of two 
years, and after this regularly at intervals of six months. 
In this way the milk teeth may be prevented from decay- 
ing, and, in addition, will not be allowed to remain in 
place after they have commenced to interfere with the 
cutting of the second set. 

Besides the washing of the hair, of which we have 
already spoken, it is of course necessary to brush it, not 
only for appearance' sake, but also because frequent 
thorough brushing improves the scalp. The hair-brush 
for the baby's first use is made of camel's hair, in order 
not to irritate the scalp. As the child's hair increases in 
quantity and becomes less fine, a coarser brush must be 
procured, with bristles stiff" enough to remove all dan- 
druff" from the skin. Combs of any sort ought to be 
employed only to part the hair, and even for this purpose 
it is not advisable to use them in infancy, except wath the 
greatest care. The hair should be trimmed often. It is 
true that short hair is not so pretty, but it adds to the 
comfort of the child, and even little girls of three or four 
years or older may wear the hair short with decided ad- 



J 



THE BABY'S CLOTHES. 83 

vantage in this respect. They will easily make up lost 
time when it is finally allowed to grow uninterruptedly. 
Certainly no boy should be made to wear long hair in 
curls after he puts on trousers, unless his mother wishes 
to subject him to the ridicule of his boy companions. 
Contrary to a commonly-accepted idea, the cutting of the 
hair has no effect in improving its growth. So, too, the 
clipping of the eyelashes does no good. They do not 
become longer as a result of this, but may grow coarse. 

The cutting of the finger-nails and toe-nails requires 
some attention. The finger-nails should be kept trimmed 
with scissors, yet not down to the quick nor too much at 
the corners. They may be kept clean with a soft nail- 
brush, and all the hang-nails be cut off close to the skin. 
The toe-nails should be cut straight across, and the cor- 
ners should never be rounded off. The following of this 
plan will aid in the prevention of ingrowing toe-nails. 

The completion of the baby's toilet — namely, dressing 
— can be more conveniently considered when studying 
the nature of the clothes, in the next chapter. 



CHAPTER V. 

THE BABY'S CLOTHES. 

In this chapter we must first consider the clothing 
required for a young infant; then that needed after short- 
ening of the clothes has taken place; and, finally, that to 
be used after baby-clothing is abandoned. The chief 
requirements of an infant's dress are looseness, softness, 
warmth, and simplicity. We usually avoid in this 
country the custom prevalent in some others — that of 
wrapping a child in swaddling-clothes in which it is 
actually rolled up like a small bundle. Yet even with us 



84 THE CARE OF THE BABY. 

infants often are not dressed in a way to allow of the 
freedom of motion that is desirable. The binder is so 
tight that the ribs and abdomen are compressed and 
digestion is greatly interfered with, and sometimes even 
vomiting is produced, and the skirts are so long that the 
baby can move its legs only with difficulty. 

The clothing should be soft and light, in order that 
the delicate baby-skin be not irritated. Not only soft- 
ness in surface but softness in texture also is required; 
that is, the material ought to be porous and not too 
heavy, in order that evaporation of perspiration and the 
proper ventilation of the skin may take place. Simplic- 
ity is also important. This does not mean merely that 
the clothing be simply made, but that the whole arrange- 
ment be simple as well. If the garments are elaborate, 
not only is the expense of providing them very greatly 
and unnecessarily increased, but, more especially, the 
temptation arises of letting them be worn too long with- 
out washing. Still, if a mother desires to make the 
baby^s clothing of this nature, there is no real objection 
to it, although it may not be wise. The other kind of 
simplicity, however, is a positive requisite. Every un- 
necessary garment renders the exertion of being dressed 
and the burden of the clothes that much greater. To be 
rolled first on its stomach and then on its back an indef- 
inite number of times while one laver of clothinor after 
another is put upon it cannot but be very distressing to 
the baby. 

Finally, and the most important of all, the child's 
clothing must be warm. Children, particularly in in- 
fancy, are peculiarly unable to resist the depressing 
effects of cold, and everv care must be taken to ofuard 
against this. In prematurely-born infants life depends 
largely upon the maintenance of the body-heat We 



THE BABY'S CLOTHES. 8$ 

all know, or ought to know, that it is not the part which 
is exposed which necessarily feels the effect of exposure. 
A child may develop pneumonia or diarrhoea just as easily 
from chilling of the arms or legs as from direct exposure 
of the chest or abdomen. Consequently, the custom of 
dressing with thin sleeves or with short dresses and bare 
legs cannot be too strongly condemned. It is a practice 
which in cool weather is both dangerous and cruel. No 
parent would be willing to dress in that way, even did 
custom sanction it. Even in summer-time it is dangerous, 
especially in infancy. A child will be little, if any, 
warmer with a thin covering over the legs, and will un- 
doubtedly be very much safer. It is a great mistake to 
try to ''harden" a child by letting draughts blow on it 
and by covering it with insufficient clothing. 

Garments which are loose, and those made of material 
of loose texture, are warmer than others, on account of 
the air which they retain in their folds and interstices; 
for air, as is well known, is a very poor conductor of 
heat. There is no material which, in theory at least, 
answers all the requirements as well as wool. It is at once 
soft, loose-textured, light, and warm. With the excep- 
tion of the diapers, all the clothing which comes next to 
the skin of the child should, when possible, be made of 
wool. Its weight must, of course, vary with the season 
of the year, and its texture should always be of the ver>' 
softest. All-wool woven material or machine-knitted 
goods serve this purpose well. 

While all-wool garments next the skin are much to 
be preferred from a hygienic point of view, there are 
some grave objections to them. First among these is 
their great tendency to shrink, and consequently to 
become both harsh in texture and much too tight. The 
fact that so many ways of preventing this have been 



S6 TtiE CARE OF THE BABY. 

proposed indicates that none of them is entirely satis- 
factory. Now and then a laundress will be found who 
really understands the washing of woollens, but this is 
certainly the exception. An underwear has been devised 
to meet this emergency. It is composed of a cotton 
back with a fleece-wool lining, and does not shrink when 
washed. Still other devices consist in the employment 
of "merino" goods, made of a mixture of cotton and 
wool. These shrink badly if too much wool is present. 

The. other chief objection is that to some babies' skins, 
particularly in hot weather, all-wool clothing is very 
irritating. In such cases a garment of silk or of linen 
may be worn under the woollen one. The latter is apt 
to be chilling, and a better practice is to use merino 
goods of a sort which contains only a small portion of 
wool, or machine-knitted goods entirely of cotton. This 
soft porous cotton stockinet, made of different thicknesses 
for summer and winter, is very satisfactory. 

Having now considered some of the general principles 
which underlie the choice of materials used in the dress- 
ing of children, we may look more in detail into the 
character of the individual articles required. Most of 
them can be made at home, and paper patterns for them 
may be bought of the dealers. It is more convenient, 
however, although less economical, to buy the gannents 
ready made, and some of the clothes, such as all the 
close-fitting ones, are much better when not made at 
home. The larger establishments for children's and in- 
fants' clothing keep a line of varying sizes and weights. 

The binder, or abdominal band, is the term applied to 
the bandage which is commonly placed around the 
child's abdomen next to the skin. Many physicians are 
opposed to it utterly, and there is no question but that it 
is capable of doing great harm if improperly used. As 



THE BABY'S CLOTHES. ^J 

a means of support it is entirely unnecessary. The only 
object of the bandage is at first to keep the umbilical 
cord from being pulled upon by the clothes, and, later, to 
furnish a loose covering to the abdomen to prevent chill- 
ing. It can be done away with if the shirt is made to 
fasten to the diaper, but on the whole it is an advantage, 
provided only we remember that most important fact, 
that a binder must never bind. Nurses are much dis- 
posed to draw it very snug. This makes colic worse 
when the baby is troubled with gas, by not allowing the 
abdomen to distend; and there is danger, too, of produ- 
cing rupture in the same way, instead of preventing it, 
as it is sometimes sup}X)sed that a close binder will do. 
The best form of binder is the knitted circular one, on 
account of the greater elasticity which it possesses. This 
can be bought ready made, or can be 
knitted or crocheted at home. It 
should be circular, and be wide enough 
to extend from the hips well over the 
ribs — that is, about six inches (Fig. 
i8). It may be made with shoulder- 
straps if desired, or may be simply 
pinned to the shirt. There is usually 
a little tab in front to which the diaper 
may be pinned. If it is desired to 
make the binder of flannel, it should 
be of the width mentioned, and long 
enough to go somewhat more than ^^'^- i8.— Abdominal 
once around the body — that is, about 
twenty inches in length. The flannel should be of the 
softest kind, cut bias in order to increase its elasticity, 
and unhemmed. The knitted binder is, however, prefer- 
able, except, possibly, for the first week of life, or until 
the cord separates. The flannel binder is more easily ap- 




SS THE CARE OF THE BABY. 

plied at this time, and occasions less danger of pulling 
the cord, but with even ordinary care the other can 
be readily used from the first. 

Diapers or napkins should be made of soft, light, and 
absorbent material, and it is important to have them not 
too heating, especially in summer. Perhaps the best 
materials are linen and cotton diaper-cloths, either of 
which is about as good as the other, excepting that the 
linen is cooler. Canton flannel is not to be recommended, 
-as it is too little absorbent, and soon becomes harsh as a 
result of washing. The diapers for the early months of 
life should be a yard long and half a yard wide. By the 
time the child is three months old the width will often 
need to be increased to twenty inches and the length also 
to double this, and by about nine months further increase 
in size must often be made. The diaper, hemmed, is 
folded into a square, and this again into a triangle, mak- 
ing four thicknesses in all. A second diaper may be 




Fig. 19. — Diaper with diaper-square. 

folded into a square and be laid under the hips to prevent 
the moisture reaching the clothes; or it may be pinned 
around the waist in the usual triangular form, but with 
the point allowed to hang down behind. Instead of this 



THE BABY'S CLOTHES. 89 

arrangement, which is rather heating and bulky, espe- 
cially in summer, it is often a good plan to use a small 
diaper folded two or more times to form a square of nine 
or eleven inches ("diaper-square") — just large enough to 
receive the urine and the passages from the bowels. This 
square is held in place by a thinner and larger linen 
diaper, which surrounds the hips in the usual way (Fig. 
19). An excellent device is the Arnold knit diaper, 
which is not only very soft and absorbent, but also is 
shaped to fit the hips, and which must be much more 
comfortable to the baby than the ordinary form is. 

A rubber or other waterproof cover should never be 
applied outside the diaper. It is very heating and is 
liable to produce chafing and eczema. 

The diapers should always be changed just as soon as 
soiled, and should on no account be put on again until 
they have been washed, even though they have been 
only moistened with colorless urine. It is always dan- 
gerous simply to dr>' them and then to use them again. 
Nothing but pure soap, not too alkaline in character, 
should be employed in washing them, and soda ought to 
be avoided carefully, as otherwise 
a great deal of irritation of the skin 
may result. They should be passed 
through several rinsings of fresh 
water, to be sure that all soap has 
been removed. After washing they 
should be aired for a day before 
they are used, in order that they 
may become thoroughly dry. All 

,. 1 , . 1 1 J Fig, 20. — Knitted sock. 

new diapers ought to be washed 

several times before the baby uses them, in order to ren- 
der them quite soft. 

Crocheted or knitted socks are an essential if the baby's 




90 TME CARE OF THE BABY, 

skirts are made as short as is advisable, and even with 
the longest skirts they are to be recommended. They 
are made of silk thread or of soft yarn, reach fully half- 
way to the knee, and tie about the ankle with a narrow 
silk ribbon or a knitted cord (Fig. 20). 

All babies are clothed in much the same way as re- 
gards the garments already mentioned, but for the rest 
we have the choice of several forms of clothing. Of 
course, various minor modifications exist, but there 
appear to be three principal styles on which these are 
based. The first or oldest style consists of a shirt, a 
skirt fastened to a broad muslin band and called a "bar- 
row coat" or "pinning blanket," often a second petti- 
coat, and then an outside dress or slip. The second 
variety is like the first, except for the important differ- 
ence that the band of the petticoat is replaced by a loose 
waist with arm-holes; or the whole garment is made in 
"Princess" style — that is, without a distinct waist. In 
the third form, very often called the "Gertrude suit," 
the ordinary shirt is done away with, and, as originally 
described, the binder also, and the costume consists of 
three garments, all of the Princess pattern. 

The first style of dressing, not so often employed now 
as formerly, is decidedly objectionable. In this the pet- 
ticoat consists of a skirt of flannel reaching below the 
feet and attached to a muslin band which is deep enough 
to reach from the armpits to the hips. This band must 
of necessity be long enough to overlap considerably, to 
permit of pinning and to give room for growth. Such a 
garment as this breaks all the rules that we discussed 
as requisite for infants' clothing. It is cumbersome, it 
is more difficult to put on, and, above all, it is too 
tight. The closeness of application required to enable 
the band to support the weight of the skirt exerts far 



I 



THE BABY'S CLOTHES. 



9t 



.(Si^^X^ 




Fig. 21.— Shirt. 



more pressure than the delicate ribs of the baby should 
receive. 

The second style of body-clothing is one which can be 
highly recommended. The shirt should be made of one 
of the materials already recommended for use next the 
skin. For winter it should be warm ; for summer, made 
of the same materials, but 
thinner, and for the hottest 
weather, very thin. In all 
seasons it should be long 
enough to reach below the 
hips, and should have sleeves 
extending to the wrists, and 
a high neck. It should be 
open the full length in front, 
and be fastened by small flat 
buttons (Fig. 21). It should 
be sufficiently loose not to 
compress the chest even after some shrinkage in wash- 
ing. A shirt with a chest-measure of fifteen inches is 
generally sufficient during the first three months of life. 
If it is too large, a smooth plait may be taken at each 
side. The shrinkage from washing can be avoided to a 
considerable extent by stretching the garment over a 
wooden form while drying. 

The best material for the petticoat is white flannel. 
The best form is one which is made throughout in 
Princess style and with arm-holes without sleeves. It 
should be open above at the back, and be made to fasten 
with one or two small flat buttons or with a narrow rib- 
bon to tie at the neck. In warm weather the petticoat 
may consist of a flannel skirt with a loose muslin waist. 

It is a great mistake to make infants' skirts too long, 
as it serves no good purpose, and impedes very greatly 
the freedom of their motions — that exercise of their legs 



92 THE CARE OF THE BABY. 

which is SO to be desired. The petticoat should reach 
not more than six to ten inches below the feet. A length 
of twenty-five inches from the neck to the hem is quite 
sufficient. Some mothers prefer to have a second cam- 
bric petticoat over this, as it prevents the flannel showing 
through the dress, but this makes an extra, unnecessary 
garment and complicates the process of dressing. 

The slip or dress is of cambric or nainsook, loose, 
and of any style that suits the mother's fancy. It 
should fasten behind with buttons or a narrow ribbon, 
and should have sleeves coming to the wrists. Its length 
should equal or slightly exceed that of the petticoat. Of 
course, both the slip and the bottom of the petticoat may 
be trimmed according to taste. 

The third style of clothing, the Gertrude suit, 'consists, 
as stated, of three garments, and neither close-fitting shirt 
nor binder is used. The use of the binder, however, 
does not interfere with the plan of the suit. All these 
garments are cut in Princess style. As originally de- 
scribed, the inner one, which takes the place of the ordi- 
nary shirt and may be called the "Gertrude shirt," con- 
sisted of Canton flannel, reached from the neck to ten 
inches below the feet — that is, was twenty-five inches 
in all in length — had sleeves to the wrist, and all the 
seams on the outside. The middle garment, correspond- 
ing to the ordinary petticoat, was of flannel, had scalloped 
neck and arm-holes without sleeves, and was half an inch 
larger around and two to four inches longer. The third 
garment, the slip, was of the ordinary material, with high 
neck and long sleeves, and was slightly wider than the last 
and thirty or more inches in length. All were fastened 
behind with two or three small buttons. The chief ad- 
vantage of this style, apart from the looseness, is the 
very great convenience in dressing. The three are put 
together, one within the other, and sleeve within sleeve, 



THE BABY'S CLOTHES. 93 

before they are put on, and then all are drawn on at one 
time as though they were but one. 

The material of the suit has since been modified in 
various ways. The inner garment is better made of 
something else than Canton flannel. One of the mate- 
rials already recommended for use next the skin is far 
superior. The second garment may be made of flannel 
for winter or of muslin for summer. The outer slip is of 
cambric or nainsook, as usual. There is no necessity of 
having the garments so long; twenty-eight inches is long 
enough for the slip, and somewhat less for the two other 
garments. This allows the child greater freedom of 
movement, yet without exposing it to danger of taking 
cold. If there is found to be a tendency for the air to 
enter at the back, owing to the fact that three garments 
open at the same position, the difficulty can be readily 
overcome by having the outer garment open in the centre 
of the back, the middle one somewhat to one side, and 
the inner one slightly toward the other side. 

The Gertrude suit is certainly an excellent one. It is 
superior to the second style described in the convenience 
attending dressing, but is perhaps inferior in that the 
under-garment does not adhere so closely to the body, 
and is therefore more apt to let the air reach the skin. 
This objection, however, is not of so much moment 
while the baby is still in long clothes. 

There are certain other suits advertised and used to 
some extent which are in all essentials made after the 
plan of the Gertrude suit device. 

If the mother desire it, she can have the baby^s clothes 
open in front instead of behind. This has the theoretical 
advantage that the child does not have to lie upon but- 
tons, tapes, or pins. Practically, it makes little differ- 
ence if the clothing is put on carefully and the child is 
not laid upon a hard surface. 



94 



THE CARE OF THE BABY. 



The length of garments in inches as given applies only 
to the first two or three months. They can, of course, be 
made with a hem sufficient to let out as the baby grows. 
So, too, the buttons can be shifted and the wrist-bands 
lengthened if the garments have been made large enough 
at the outset. It is better, however, not to have too many 
clothes at first, and to buy or make larger sizes as needed. 
The clothes for the night should be a complete change 
from those worn during the day. They consist of a 
binder, a diaper, a shirt either of the ordinary pattern or 
of the Gertrude style, according to preference, and an 
outer night-slip. This latter should be longer than the 
day-slip, and very roomy in order to allow of free move- 
ment of the legs. For winter-time it should be of flan- 
nel or Canton flannel and made to close with a draw- 
ing-string or with buttons at the bottom (Fig. 22). For 
hot summer weather it may be of muslin, 
and need not be fastened below. The 
baby requires no socks when in bed, but 
needs some night-socks to slip on when it 
has to be taken up. The necessity for 
fastening down the bed-covers if the baby 
is restless is referred to again in the chap- 
ter on Sleep. 

A certain number of garments are needed 
besides those mentioned. There is, in the 
first place, the old blanket in which the 
child shall be received immediately after 
birth, and which has been spoken of in 
describing the contents of the baby's bas- 
ket in Chapter IV. There should also be 
a warm shawl or shoulder-blanket, made 
of very soft flannel, which can be thrown 
about the baby and over its head w^hen it 
is carried from one room to another or w^hen it is taken 




Fig, 22, — Night- 
gown closed by a 
drawing - string at 
the bottom. 



THE BABY'S CLOTHES. 95 

up at night. The shoulder-blanket should not be used 
except under these circumstances. A cap to be worn in 
the house is not needed unless the child shows a great 
disposition to take cold. A thin cambric cap is then 
sufficient, but even this should not be used except by the 
advice of the physician in charge. A knitted worsted 
sack is often useful if the room happens to be cooler than 
usual. A flannel or w^ash-flannel wrapper is also very ser- 
viceable in the mornings, before the baby receives its bath. 

The clothing for use out of doors varies, of course, 
with the season. In winter there is needed a long, very 
warm cloak of some woollen material such as cashmere; 
a warm thick hood covering the ears; a Shetland veil if 
the weather is windy or cold; and warm knitted mit- 
tens. In hot summer weather only a cap is required. 
This should be thin, of cambric or silk. 

We may pause here just a moment over the steps to be 
followed in the actual process of dressing a young infant, 
although this is something which seems to come almost 
intuitively to most mothers. After the new-born baby is 
bathed and dried it is laid upon its back in the nurse's 
lap, with the diaper in position under its hips. If a 
binder of flannel is used, it should at the same time be 
laid in place under the back. The stump of the umbil- 
ical cord is now dressed. The best method of doing this 
is to envelop it well in salicylated absorbent cotton, 
which can be procured at any first-class drug-store. It 
is then wrapped about with thread and laid against the 
abdomen upon the left side. The binder is then brought 
up from each side and pinned with safety-pins, or, if the 
circular knitted binder is used, is drawn up over the feet. 
It ought always to be so loose that the hand will slip 
easily between it and the skin. The diaper is now brought 
around and pinned, taking care that the hand can slip 



96 THE CARE OF THE BABY. 

under it readily, as in the case of the binder. The socks 
are next put on, and then the shirt. The petticoat and 
dress are first adjusted to each other and are then slipped 
on together over the head. If the Gertrude suit is used, 
all three garments are slipped over the head at one time 
after having first been put together, sleeve within sleeve. 

At bed-time all clothing worn during the day is re- 
moved, a fresh binder and diaper are applied, and the 
night-clothes put on. If the Gertrude clothing is used, 
the under-garment and the night-gown are first fitted 
together and are then put on at the same time. 

Every day, at the time of the morning bath, the um- 
bilical cord must be carefully freed from the cotton, using 
great caution to avoid pulling it. After the bath it may 
be powdered with boric acid if there is any moisture or 
unpleasant odor about it, and a fresh dressing of cotton 
must be applied. By the fourth or fifth day the stump 
will have fallen off and the dressing of the cord will no 
longer be required. If the baby is sponged instead of 
being put in the tub during the first few days of life, 
there is no need to remove the original dressing from 
the cord, provided it seems dry and entirely without 
odor. 

There is scarcely anything about which there is so little 
uniformity of opinion as the number of changes of cloth- 
ing which should be provided in advance for the baby. 
This is not only because mothers V2X\ in the frequency 
with which they have laundr}^ work done, but also be- 
cause the number of garments which can be made to 
answer very well where economy is a matter of considera- 
tion may not seem at all suflficient to those anxious to 
have the baby very abundantly supplied. 

The following list of clothing — the layette, as it is com- 
monly called — may be considered one of average size: 



THE BABY'S CLOTHES 97 

Long Clothes. 

Flannel binders 2 

Knitted bands 4 

Diapers 4 dozen or more. 

Shirts, close-fitting or Gertrude 6 

Petticoats, flannel, or second Gertrude garment . . 4 

Petticoats, cambric (if desired) 4 

Slips 8 

Socks 6 pairs. 

Night-gowns 6 

Wrappers 3 

Sacks, knitted 2 

Cloak I 

Hood I 

Mittens i pair. 

Veil I 

Shoulder-blankets 2 

There are certain other articles to be provided in ad- 
\ance, bnt they are more appropriately described else- 
where, when considering the baby's basket and the 
baby's bed. There is one, however, and a very service- 
able one, which may be mentioned here — namely, the 
lap-protector, although this is rather for the mother's use 
than for the baby's. A ver>' good pattern is shaped like 
a pillow-case, fastens at one end by buttons, and is made 
of corduroy, Turkish toweling, or some similar thick, 
washable material. It may be trimmed simply in any 
way desired. A doubled piece of rubber sheeting is made 
to slip inside of it. The rubber may be slipped out, and 
both it and the case washed when soiled. Instead of this, 
lap-protectors may be made of squares of nurser}' cloth, 
which can be thrown away when soiled. Still another 
useful article is a small soft pillow on which the baby 
can lie or be carried about during the early wrecks of life. 

When the baby has reached the age of six months, 
more or less, depending on the season of the year, the 
7 



98 THE CARE OF THE BABY. 

time for "shortening^' the clothes, or "short-coating," 
has come. The change should not be made in winter if 
it can be avoided. The number and material of the gar- 
ments remain nearly the same as before. The shortening 
may be accomplished by cutting down the skirts of the 
long clothes already in use, lengthening the sleeves, and 
letting out the waists if they have been made sufficiently 
large at first to allow of this. In the case of the Ger- 
trude suit, however, the shortened skirts, reaching, as 
they do, only to the ankles or a little higher, allow too 
free access of air to the trunk. It is therefore advisable 
to replace the inner loose garment by a close-fitting, long- 
sleeved, and high-necked shirt. The use of the binder 
is continued. Short clothes also necessitate a decided 
change in the covering of the feet and legs, which would 
otherwise be left too much exposed to the air. There is, 
of course, a great temptation for the admiring mother to 
leave the baby's plump little legs bare, but the practice 
is capable of doing great harm. There should be stock- 
ings long enough to reach to the diaper. They may be 
pinned to this, but a better way is to button them to 
broad elastic bands which can be buttoned or tied to tapes 
fastened to the inside of the upper part of the petticoat. 
Stockings of wool or of partly woollen goods, and of a 
thickness varying with the season of the year, are prob- 
ably to be preferred, but they frequently shrink so badly 
that raw silk or cotton stockings are often more practi- 
cally useful, especially in summer-time. The shrinking 
may be prevented to a considerable extent by stretching 
them over a wooden stocking-frame while drying. The 
toe should not be pointed, and the whole stocking-foot 
should not fit too closely, since the constant elastic pres- 
sure which it exerts may do harm. Indeed, the stock- 
ings ought to be rights and lefts, and narrowed off on the 



THE BABY'S CLOTHES. 



99 



outside of the foot, if such forms cau be bought or made. 
A great breadth of toe is ver}' desirable. Care must be 
obser\'ed that the interior is perfectly smooth and free 
from loose threads, knots, and wrinkles. 

The stockings should be white or of some color which is 
known not to contain any injurious substance capable of 
irritating the skin. In winter it is sometimes of advan- 
tage to furnish a child in short clothes with drawers also. 
These may be made of woollen or merino goods or of Can- 
ton flannel. It is convenient to make the legs separate, 
to button or pin to the upper part of the petticoat. They 
should fit rather closely and should reach to the shoe-tops 
(Fig. 23). Drawers of this pattern combined with the 
use of short stockings may entirely take the place of long 
stockings throughout the year, if it is so desired. In this 
case their weight varies, of course, with the season. Ex- 
cept that they are more easily changed when wet, they 
have no special advantage over 
long stockings, and the latter 
alone generally answer every pur- 
pose until the age when the dia- 
per is abandoned. 

When the baby becomes more 
active, and especially when it be- 
gins to creep or to stand, there is 
often a great deal of trouble with 
the diapers, which exhibit a tend- 
ency to fall off at the most inop- ^^'G. 23.— Drawers with sepa- 

portune moments, unless drawn ^^^^ ^^^^• 

much more tightly than is healthful. To obviate this 
difficulty the diapers may be pinned to the merino shirt, 
provided little squares of muslin be first sewed on 
the latter, to prevent the pins tearing holes; or the 
binder may be made with shoulder-straps and with a little 




lOO 



THE CARE OF THE BABY. 



tag in front to which the diaper can be attached. Dia- 
per-suspenders have been recommended to meet the dif- 
ficulty: they consist of a band of muslin about three 
inches wide, and long enough to go around the waist 
and to button in front. Two pieces of white silk elastic 
are attached to this, as shown in the illustration (Fig. 
24), so as to cross over the shoulders. A little tag is 

sewed on one end of the 
band, and another at the 
middle, and to these the 
diaper is pinned after the 
suspenders have been ap- 
plied outside of the shirt. 
Very neat and light little 
waists can be bought or 
made, and to these both 




Fig. 24. — Diaper-suspenders. 



diapers and stockings may be fastened, in place of any 
of the plans mentioned. 

With the short dresses the baby may put on shoes, 
although it does not really need them until it begins to 
stand or to creep. In place of these we may at first use 
moccasins of chamois leather, kid, or felt. These are for 
sale in the shops, but they can be easily made at home. 
They form a very serviceable foot-covering, although 
there is difficulty in keeping them on unless they are 
well made and rather high on the ankle. The first real 
shoes should be of soft kid, with kid or thin leather soles, 
and of course without heels. Their shape is of great 
importance, since the softness of the tissues renders the 
deforming of the feet by improper shoes very easy. Not 
only should the shoe be somewhat longer than the foot 
and fully as wide, but it should be made to fit the foot, 
not the foot forced to fit the shoe. The toe should be 
wide and loose to permit the foot to spread, but the 



THE BABY'S CLOTHES. 



lOI 



instep and heel should fit closely or the foot will turn and 
rub. Flat laces are better than buttons, since they allow 
of a more perfect adaptation. The shoes ought always 
to be rights and lefts, for, although a baby's foot is fat 




Fig. 25. — Imprint of foot (from 
life, three-quarters natural size). 




Fig. 26. — Outline of sole of shoe 
to fit Fig. 25. 



and plump, it is in reality built on exactly the same 
lines as the adult foot — that is, the undeformed adult foot, 
The illustration (Fig. 25) is of the sole of the right foot 
of a child of thirteen months. It is a reproduction from 
life, reduced to three-quarters of the natural size, made 
by rubbing the sole with a little lampblack stirred in 
turpentine and sweet oil, and then pressing it against 
blotting-paper pinned on a board. The illustration 
seems unnatural and distorted at first sight, yet it shows 
how a foot actually presses upon the ground in walking, 
and proves the great importance of having the shoes 
rights and lefts even from the beginning. The out- 



I02 THE CARE OF THE BABY, 

line in the adjoining illustration (Fig. 26) represents the 
shape of the sole of a shoe which would fit this foot. For 
actual use it should, of course, be made slightly larger in 
order to keep the uppers from exercising undue pressure. 

Shoes of a proper pattern are difficult to obtain, since 
shoemakers find it easier to make them on the old 
model, according to which either one will fit equally 
well — or, rather, equally ill — on either foot. I\Ir. W. H. 
Steigerwalt, of Philadelphia, has for some years been 
making suitable shoes for the period of later childhood, 
and was furnishing very broad-toed shoes, but not rights 
and lefts, for use in infancy. At my suggestion he now 
provides shoes which are rights and lefts, and which con- 
form to the natural shape of the foot of the youngest age 
needing shoes at all. 

Sometimes a baby suffers greatly from cold feet shortly 
after it first begins to wear stockings and shoes. Fre- 
quent rubbing of the bare feet and the making of the 
shoes somewhat looser about the instep and ankle will 
overcome the trouble. After the baby is walking out of 
doors the thickness and stiffness of the sole must be 
increased, to protect the foot from being injured b}' irreg- 
ularities in the ground. 

Knitted sacks are still needed during the time short 
infant-clothing is worn, and wrappers serve the same 
purpose as before. The wrapper should be long and 
loose, and neither it nor the night-slip partakes in the 
general shortening. Even before the time of shortening, 
bibs may be needed to catch the greatly increased flow of 
saliva. These should be made of soft, absorbent cotton 
material, and be quilted. There is no objection to the 
placing of a somewhat smaller bib of rubber cloth under 
the cotton one. I^ater, larger bibs will be required for 
use when the child is eating. A very ser\'iceable article 



THE BABY'S CLOTHES. 



103 



when the baby begins to creep is a creeping apron. The 
drawers already described answer to a certain extent, but 
a much better device is the creeping apron shown in the 
ilhistration (Fig. 27). The lower portion consists of a 
wide, roomy, bag-like skirt, closed at the bottom and 
large enough to hold the skirts easily. This is fastened 
to a yoke above, which is provided with wide sleeves and 
wide arm-holes to permit of 
the arms easily slipping into 
them. At the lower end of 
the apron are two openings for 
the legs. These are gathered 
into bands fitted to the legs 
and are made to fasten below 
the knee. There should be a 
distance of fifteen inches be- 
tween the holes. The whole 
width of the skirt at the lower 
end should be twenty-seven 
or more inches. This device 
will effectually protect all the gannents and will check 
the action of draughts along the floor. Creeping aprons 
of this description can easily be made at home, but can- 
not, I think, be bought in the shops. If the mother 
finds the upper portion to be too warm, the yoke and 
sleeves may be dispensed with, and the bag-skirt be 
gathered into a band, from which shoulder-straps may 
pass over the shoulders and cross over the back. Of 
course this latter plan fails to prevent the sleeves of the 
baby's slip from becoming soiled. 

There is a form of creeping apron sometimes recom- 
mended and sold which should be avoided. It consists 
of a very wide pinafore gathered at the bottom of the 
skirt into a band, which fastens around the waist under 




Fig. 27. — Crccpmi; apruii. 



104 ^-^^ CARE OF THE BABY. 

the clothes. This arrangement protects the clothing 
well, but leaves the legs more than usually exposed, 
since it holds the skirts away from them. 

For outdoor use a coat which is shorter than the long 
cloak of infancy is needed after the child has learned to 
walk. Warm knitted leggings which cover the whole 
lower half of the body up to the waist are serviceable in 
cold weather. Those made of Jersey are still better, as 
they are just as warm and much less bulky. 

The following list may serve as a guide to the number 
of garments needed at this time of life: 

Short Clothes. 

Knitted binders 4 

Diapers 4 dozen. 

Shirts, close-fitting 6 

Petticoats, flannel 4 

Petticoats, cambric (if desired) 4 

Dresses 8 to 12 

Stockings 8 to 12 pairs. 

Shoes 2 pairs. 

Drawers (if desired) 8 to 12 pairs. 

Creeping aprons 2 

Wrappers 3 

Sacks 3 

Bibs 12 

Night-gowns 6 

Cloak or coat i 

Hood or cap i 

Leggings i pair. 

Veil I 

Mittens i pair. 

The time for changing from the clothing of infancy to 
that of childhood depends not so much upon the age as 
upon the time when the baby learns to do without a 
diaper. Two years of age is a very late period for acquir- 
ing the proper control, and most children should be able 



THE BABY'S CLOTHES. I05 

to have the change made by a year or earlier, at least 
during the day-time, if there has been careful training. 

After the change has been made it is still important 
to ensure thorough protection against cold, while at the 
same time the clothes are loose. The style of gannents 
and their number is a matter of minor consequence, and 
may be determined largely according to the fancy of the 
mother, although the binder should be worn until the 
age of two years. With the exception of the head and 
hands, no part of the body should be left exposed to the 
air, unless it be on the very hottest days of summer, and 
even then the child is little, if any, warmer, and is cer- 
tainly much safer, if fully covered with garments of very 
light weight and texture. The undershirt should be 
long-sleeved and high-necked, and of woollen or merino 
of a thickness depending on the season of the year. 
The drawers for winter use should be of the warmest 
material, such as Canton flannel or closely fitting 
woollen goods. The stockings should vary in thick- 
ness with the season, but should always be long. A 
loosely-fitting, high-necked, sleeveless waist, of warm 
material for winter and of muslin for summer, is conve- 
niently worn over the shirt. To this the stocking-sup- 
porters and drawers are attached, and in summer the 
white skirt as well. Circular garters ought never to be 
worn. In winter the child must wear, in addition, a 
flannel skirt attached to a waist of its own, to which the 
white skirt also may be buttoned. 

The child's outer dress may be of material, quality, 
and ornamentation in accord with the season and the pre- 
vailing styles. It is the custom to keep children in white 
dresses until the age of two or three years. If colors in 
light woollen material, or in cottons for summer, are 
preferred on account of the saving of laundry work, it is 



I06 THE CARE OF THE BABY. 

well to remember that certain colors for use in the sun- 
shine are much hotter than others. Black is twice as 
hot as white, and blue, even light blue, nearly as hot as 
black. Red stands about midway between black and 
white, with green hotter and yellow cooler than it. 

The long skirts reaching almost to the ground, which 
have been at times the fashion for small children, espe- 
cially girls, are not at all to be recommended. They are 
very much in the way, and oppose a great hinderance to 
the active movements which are so much to be desired. 

As the child grows older its style of dressing will, of 
course, vary according as it is a girl or a boy. The time 
and manner of showing the difference of sex by the dress 
is not a matter with which we can concern ourselves 
greatly in a book of this nature, and we must consider it 
only briefly. No change at all is made until the age of 
two years or older, depending upon the size of the child. 
At this time boys wear dresses made with box plaits from 
the neck, held in at the back by a belt which comes 
from the side seams, or, if preferred, goes entirely around 
the waist; while girls still wear the baby-dress, gathered 
in a yoke. At three or four years of age, depending on 
the size and shape of the child, the boy is put into trou- 
sers, either knickerbockers or the popular sailor costume. 

An important matter, with girls just as much as with 
boys, is that the same precautions to ensure looseness and 
warmth of the clothing shall be taken at this age as 
earlier in life. If corsets must finally be worn — as inex- 
orable Fashion still says they must — let the girl in her 
formative stage defer adopting them, or even corset- 
waists, just as long as possible. Her whole future well- 
being may depend upon this and similar early provisions 
for her health. There is nothing in all this which means 
that her clothes shall look uo^lv or ill-fittinor. 



THE BABY'S CLOTHES. 



107 



The night-dress of children who have ceased to wear 
baby clothes consists of a merino shirt, of thickness vary- 
ing with the season, and of night-drawers which are of 
Canton flannel in winter and nuislin in summer. The 
very frequent tendency which some children have to toss 
off the night-covering often renders it advisable to pro- 
vide the drawers with feet, so that 
the whole body except the head and 
hands is constantly covered (Fig. 28). 
A slit at the ankle allows the foot to 
be pushed through and the stocking 
to be put on in the morning without 
exposing the child. Not until well 
on in later childhood, at least in win- 
ter, should night-gowns be made for 
the girls, and night-shirts, or, still 
better, pajamas, for the boys. 

For out-of-door wear both sexes 
continue to wear caps until about 
the age of two years, when boys 
generally replace them by little hats. 
The use of a warm hood, or of some 
other form of head-covering which 
protects the ears, should certainly be 
adopted in winter. Warm wraps and 
coats are needed in winter, their na- 
ture depending upon the child's age 
and sex. The soles of the shoes are 
gradually increased in thickness as the child grows older, 
and at about the age of three or four years the part under 
the heel is made slightly thicker—/, e. has a ''spring." 
The spring is later made somewhat more pronounced, 
but it is only, as a rule, at about the age of ten or eleven 
years that actual heels are used. Sometimes boys' shoes 




Fig. 2S. — Night-drawers 
with closed feet. 



I08 THE CARE OF THE BABY. 

are given heels somewhat earlier, in order to make a dis- 
tinction from the shoes of girls. Leather leggings lined 
with flannel are very popular for children of three or 
four years and over. Rubber over-shoes should always 
be worn if the ground is at all damp. Rubber boots 
permit the child to play in the snow or on ver}^ wet 
ground. In later childhood mackintoshes serve to 
protect from rain. Before this time it is better that 
the child stay in the house in rainy weather. • We must 
never forget the possible danger of contracting cold after 
the use of waterproof clothing, from the fact that the 
body becomes damp from the retained perspiration. After 
the use of rubber boots the feet should be thoroughly 
dried and the stockings changed. 

The following list represents the clothes required for 
late infancy and early childhood up to the period when 
trousers are adopted by the boy. More drawers are 
needed at first than later, on account of the occasional 
lapses in the recently acquired control over the bladder. 

ClvOTHING FOR LATE INFANCY AND EARLIEST CHILDHOOD. 

Binders (up to two 5'ears of age) 4 

Shirts 6 

Drawers 6 to 12 

Stockings 6 to 8 pairs. 

Shoes 2 pairs. 

Underwaists 4 

Flannel skirts with waists attached 4 

White skirts 4 

Dresses 6 to 12 

Night-drawers 4 

Sacks 2 

Cap or hat i 

Leggings i pair. 

Coat I 

Mittens or gloves i pair. 

Rubber shoes i pair. 



FEEDI.VG THE BABY. IO9 

A few very brief comments are necessary regarding the 
clothing required during sickness. When the child is in 
bed it should be dressed in night-clothes identical with 
those usually worn. The garments should be changed 
night and morning, and be aired and warmed thoroughly 
before they are used again. There is seldom, if ever, 
any necessity of making a child go without changing its 
clothing for days or weeks for fear it will take cold. If 
the change is made properly, there is no risk. It is very 
important that the arms and chest be well covered with a 
sack of some sort when the child is awake. After it is 
well enough to be out of bed and to sit in a chair a flan- 
nel wrapper and knit or felt shoes are useful. Slippers 
are often dangerous, as they expose the feet to draughts. 



CHAPTER VI. 
FEEDING THE BABY. 

In this chapter we shall consider what is often one of 
the most difficult of all the questions of babyhood; the 
rock upon which manv and uianv a little l^ark has made 
shipwreck. 

There are but two ways to feed an infant — namely, 
either on human milk at the breast of the mother or of 
a wet-nurse, or upon an artificially prepared milk diet — 
and we have the two corresponding classes of the breast- 
fed and the bottle-fed baby. Happy are the little ones 
who belong to the first class, for there is no question 
whatever that the natural and proper food for infants is 
human milk. Statistics show beyond doubt that breast- 
fed babies as a class are larger and healthier than the 
bottle-fed ones, and that the mortality among them is far 
less. The most careful preparation cannot possibly 



no THE CARE OF THE BABY. 

make the milk of another animal chemically identical 
with that of a woman or similar in its eflfects on the child. 
It is undoubtedly true that the demands made upon the 
time of the nursing mother are most exacting, and that 
nursing is probably much the greatest inconvenience of 
motherhood. Still, the mother-love should certainly 
prompt the self-sacrifice. 

Let us, then, first consider breast-feeding. Many vary- 
ing directions are given regarding the time when the 
baby should be first put to the breast. We cannot do 
better in this respect than treat the child like any other 
little new-born animal which is not prevented by cast- 
iron rules from nursing as soon as it feels inclined. The 
natural instinct of a baby is to suck, and it should be 
allowed to do this as soon as the mother feels sufficiently 
rested to permit it, after both she and the child have been 
washed and dressed. This practice of early nursing is a 
good one, for the reason that it tends to ensure thorough 
contraction of the womb. It is true that there is ver)- 
little in the breast during the first two or three days. 
There is usually something, however — a thin, yellowish, 
sticky fluid looking like poorly-developed milk, and 
called colostriun. This is of a peculiar character, since, 
besides being of a nourishing nature, it has a somewhat 
purgative action upon the child's bowels, and it is advis- 
able that these be well opened early and the blackish 
contents (ineconiiiui) discharged. It is only by about 
the third day after confinement that the secretion of milk 
becomes well established. 

The early sucking by the child fulfils still other pur- 
poses besides those mentioned. It both stimulates the 
secretion of milk and draws out the nipples into better 
shape for the baby's future use. If the nipple is some- 
what depressed or poorly developed, it is much easier for 



FEEDIXG THE BABY. Ill 

the child to suck at it while the breast is still flaccid 
than after it has become full and tense with the con- 
tained milk. 

Many monthly nurses wish to feed the child during the 
first day or two of life with sweetened water, gruel, or 
other substances. This is usually totally unnecessary, 
and is often harmful. If the child really seems to be 
ravenously hungry, as shown by the avidity with which 
it grasps the nipple and the cries which it persistently 
utters, it may be given a very little cow's milk prepared 
according to the method to be considered later; but such 
a necessity rarely arises. Often a little moderately hot 
water will satisfy the child perfectly. During the first 
six weeks of life the child should be put to the breast 
regularly every two or two and a half hours during 
the day, and from this up to the time of weaning 
every three or four hours. It should be trained as 
far as possible to do without nursing at night — from 
ten in the evening to early in the morning. The 
tables given on pages 127 and 128 for guidance in the 
frequency of the feeding of bottle-babies apply equally 
to those nursed at the breast. Too much stress can- 
not be laid on the importance of regularity in nurs- 
ing. No fault is more common and more pernicious 
than that of suckling a child every time it cries, and 
simply for the sake of quieting it. The temptation to do 
this is great, it is true, but the final results are evil, for 
the baby's digestion is almost sure to suffer, and its dis- 
position to cry to become worse and worse. Moreover, a 
baby is to a wonderful degree a creature of routine, and 
when once it becomes a ''slave to bad habits" it will 
make everyone connected with it a slave to itself It 
should never be allowed to go to sleep at the breast with 
the nipple in its mouth, but should be kept awake until 



I 1 2 THE CARE OF THE BAB Y. 

it has finished or else be removed entirely. By the time 
of the next nursing it will be hungry enough to keep 
awake. 

It is a great mistake to suppose that every cry that 
stops temporarily during nursing denotes hunger. Often 
the child is thirsty, and a little water is really what it 
needs. This necessity of giving the baby water is very 
commonly forgotten. A nursing infant should have 
water offered to it several times a day. So, too, the stop- 
ping of a cry by nursing may occur because the entrance 
of the warm milk into the stomach temporarily relieves 
pain — only, of course, to increase the indigestion and to 
give worse colic presently. 

The mother also suffers from too frequent nursing, for 
not only is she then at the mercy of the child's habits, but 
she is extremely liable to develop cracked nipples as the 
result of the constant moistening. 

The baby while nursing ffom the left breast should be 
held on its right side with its head supported by the left 
arm of the mother. The mother should be propped slightly 
in bed with a pillow or should lie upon her side. After her 
convalescence she should lean a little forward while nurs- 
ing, so that the nipple points somewhat downward toward 
the child's mouth, and should slightly steady and elevate 
the breast with the first two fingers of the right hand to 
keep the weight from pressing upon its nose. If the child 
nurses too rapidly, the nipple should be withdrawn now 
and then to prevent its choking and to allow it to 
breathe. If the milk flows too freely of itself, it may be 
restrained by pressing the base of the nipple between the 
fingers and thumb; while if, on the other hand, it does 
not come quickly enough, and a delicate child seems 
unable to draw sufficient nourishment, the pressure of 
the hand upon the breast will aid in expelling it. In 



FEEDING THE BABY. II3 

nursing from the right breast the position is of course 
reversed, and the child lies upon its left side. In rare 
instances, however, it will vomit if in this position while 
nursing, owing to the pressure of the liver upon the 
stomach. In such a case it may lie upon its right side 
with its legs tucked under the mother's right arm. 

If there is an abundance of milk, one breast is sufficient 
for one nursing, and the baby empties it after ten or 
fifteen minutes, is satisfied, falls asleep, and should at 
once be removed. The other breast should be reserved 
for the next nursing. The quantity of milk which a 
mother secretes during the first weeks of a baby's life is 
about one pint in twenty-four hours. Later the amount 
is increased as the needs of the child grow greater. 
Generally the mother at first has more milk than a baby 
can digest. A kind provision of nature prevents the 
over-feeding in which a strong baby indulges from doing 
it any harm, for the stomach simply rejects the over- 
supply, which comes up again just as it went down. It 
is not a true, forcible vomiting, such as occurs in older 
children, but is a simple regurgitation unattended by 
nausea, and need give the mother no immediate anxiety, 
provided the milk has no very sour odor and the health 
seems perfect. At the same time the trouble should be 
corrected by not allowing the baby to nurse quite so 
long or so often. 

In this connection we must consider the way in which 
a nursing mother ought to conduct her life, since upon 
this the health of the baby will depend. Her diet is a 
matter of much importance. What she shall eat during 
the time she is confined to bed will be carefully ordered 
by her physician. It is generally customary to alter the 
diet to some degree, either in quantity or in quality, since 
the confinement in bed may diminish somewhat the 



114 THE CARE OF THE BABY. 

power of digestion. This is especially true of the first 
couple of days. After the mother is up and about 
she becomes her own mistress in this matter, and must 
determine for herself what is best for her. She should 
use every means to preserve her digestion in the very 
best condition by observing regularity in the time of 
meals, by eating slowly and masticating thoroughly, and 
by consuming only those things which are digestible and 
nutritious. 

There is a commonly prevailing notion that various 
substances must be avoided because they will give the 
baby colic by altering the milk. This is true only to 
a very limited extent, and generally only in so far as 
the mother's digestion is disturbed by what she has 
taken ; for it is certain that indigestion in the mother, 
by whatever means produced, is liable to be followed 
by indigestion in the child. It may sometimes happen, 
however, that raw fruit or acid substances eaten by 
the mother may, without affecting her digestion at all, in 
some way alter her milk and disagree with the baby; but 
this is rather the exception than the rule. It is also true 
that such articles of diet as onions, turnips, cauliflower, 
and cabbage, which have very distinct odors and tastes, 
are sometimes capable of imparting an unpleasant taste 
to the mother's milk, just as cow's milk may taste dis- 
agreeably of garlic. Most mothers, however, who have 
perfect digestion can eat nearly everything digestible 
without fear of affecting the baby. 

It is certainly true that there are drugs which, when 
taken by the mother, enter her milk, and it would some- 
times be possible for physicians to treat the child in this 
way. This is true of some of the purgative drugs and 
of certain others, but even in the case of medicines, as 
with foods, most mothers may be, to all intents, free 



FEEDING THE BABY. II5 

from anxiety regarding the eflfect on. the baby of any- 
thing they may need to take. 

With regard to the use of stimulants, the nursing 
mother should follow her former habit of life if her 
health seems good. If she is delicate or weak she may 
find stimulants of service, but the advice of a physician 
had better be obtained in any case. 

Not infrequently there is an insufficient supply of milk, 
and the question arises whether the amount can be in- 
creased in any way. The drinking of large quantities 
of cow's milk, the use of various milk foods, soups, and 
perhaps of malted liquor in some form, may be of advan- 
tage. One of the thinner extracts of malt is often use- 
ful. It must be remembered, however, that increasing 
the secretion of milk does not necessarily increase its 
nourishing power, and that to take a large amount of 
liquid nourishment is sometimes only to play a decep- 
tion upon the baby. It may be merely following the 
example of the milkman who invokes the aid of the 
well-pump ; for, although the quantity secreted may 
be larger, the milk may be more watery and the 
actual amount of nourishment in twenty-four hours 
may be just the same as before. Still, much may often 
be done to alter the character of the milk, as we shall 
see presently. 

Equally important with proper diet is regular exercise 
and the enjoyment of fresh air, either on foot or in a car- 
riage. Late hours must be avoided, as must all sources 
of worry, anxiety, and nervous excitement. It is a not 
infrequent occurrence for the milk secreted shortly after 
a mother has experienced fright, violent anger, or other 
very powerful emotion to act as an intense poison to the 
baby. If a mother has been subjected to any such in- 
fluence, it is better to empty the breast with the pump 



Il6 THE CARE OF THE BABY. 

and to avoid nursing for a number of hours, substituting 
artificially prepared milk for the time being. ** 

The ability of the mother to nurse her child often 
depends upon the condition of her nipples. They should 
have been attended to during pregnancy, in the manner 
already described in Chapter I. In spite of all efforts, 
however, the birth of the child may find the nipples unfit 
for nursing. Their shape may be such that the baby can 
obtain no satisfactory hold, and in 
such a case an artificial nipple must 
be tried. There are many varieties of 
these, but those of the simplest con- 
struction should be chosen, as it is 
very necessary to keep them perfectly 
clean. One of the best consists of 
a glass base upon which is fitted a 
detachable rubber teat (Fig. 29). 
Such an apparatus may prove satis- 
^'''' ^^7-^^^"^'^ factor>', and the effort to use it should 
always be made, but very frequently 
a badly-developed nipple will make it necessary to aban- 
don nursing. 

To keep the nipple in a good condition a mother 
should observe the req-ular times for nursing^ as alreadv 
referred to, and should invariably and immediately after 
nursing dry the nipples gently and thoroughly with a 
soft cloth, and then, for the first week or two, smear 
them with a little sweet oil. 

If the nipple becomes slightly raw or sore, it may after 
being dried have a special bismuth preparation applied 
and allowed to remain (Appendix, 74). It is important, 
too, to protect it carefully from any friction of the cloth- 
ing, possibly by the use of some form of nipple-shield, if 
the doctor sanctions it. Before nursinof a^ain the bis- 




FEEDING THE BABY. II7 

miith application may be wiped away gently, but there 
is no need to do this very thoroughly, as it is not injuri- 
ous to the child if It is swallowed. The use of an arti- 
ficial nipple for a few days is to be recommended should 
the nipple be even only slightly sore. 

Should nursing become actually painful, a physician 
ought to be consulted immediately, for it is much easier 
to treat the fissures in the early stages than after they 
have become deep. If neglected, the pain of nursing 
may become simply unendurable. 

Sometimes the flow of milk is so great that even a 
strong baby cannot manage to take it all, and a constant 
hard distention of the breast, usually described as ''caked 
breast " or " milk cake, ' ' results. Unless this is promptly 
relieved there is great danger of an abscess forming. To 
prevent or relieve caking in such cases the breast requires 
long-continued and gentle but firm rubbing with warm 
sweet oil from the circumference toward the nipple, and 
the occasional application of the breast-pump (p. 27) to 
supplement the sucking by the child. The mother must 
on no account fail to consult her physician at once re- 
garding the diflficulty, and should not depend solely on 
the ministrations of the monthly nurse, as the matter is 
quite too serious for this. 

Eventually the baby must be weaned — that is, cease 
entirely to receive human milk, and be placed on a diet 
of another nature. The method of doing this and the 
age at which it shall be done vary somewhat with cir- 
cumstances. Some physicians advise that the baby 
begin to receive a small amount of artificial food when 
it reaches the age of five or six months, or even earlier 
than this, on the ground that its dependence upon 
mother's milk is thus rendered less absolute, and that it 
will not be subjected to the dangers which sudden wean- 



Il8 THE CARE OF THE BABY. 

ing entails should the milk of the mother rapidly ?Pi:y up. 
Although there is a degree of truth in this, yet it seems 
like guarding against a possible danger by incurring a 
very certain one — that of injuring the child's digestion; 
for experience shows that there are numberless instances 
of severe illness, and even of death, which have resulted 
from the early effort to replace mother's milk by cow's 
milk or other food, no matter how carefully prepared. 

Yet there is a mother's side to the question, for there 
is no doubt that the feeding of her baby month after 
month, from the breast alone renders her life very much 
confined and is a great drain upon her system, and in 
many instances her health, not only immediate but fu- 
ture, cannot endure it. In such cases, even when there 
is an abundance of breast-milk, the plan of giving one or 
possibly two bottles a day is to be thoughtfully considered. 
The substitution, however, should only be tried with the 
advice and under the supervision of the family physician. 
Certainly the safest course for the baby is that of feeding 
it solely from the breast until the age for weaning comes. 

So, too, if the baby ceases to grow at a proper rate, 
and it is proven that the breast-milk is insufficient in 
quantity or quality, the doctor may decide to combine 
artificial feeding with nursing. 

Ordinarily, weaning should take place at about the 
age of ten or eleven months. Longer nursing than this 
is generally too wearing upon the mother, and is also bad 
for the child, whose health is very likely to be impaired 
as a result of the breast-milk becoming thin and poor. 
Of course, the exact age to wean must depend on circum- 
stances. If the mother remains perfectly strong and the 
baby continues in the very best condition, it may be 
nursed until it is a year old, while the reverse of this 
may make early weaning necessary. Another very im- 



FEEDING THE BABY. I I9 

portant matter is the season of the year. It is very bad 
policy to wean a child at the beginning of hot summer 
weather if it can be avoided in any way. It is certainly 
better to defer it until autumn, and to make up with 
artificial food any deficiency in the natural nourishment. 
Still another matter of some, though of less, importance 
is not to choose for weaning a period at which the baby 
is cutting a tooth. 

Weaning is best done somewhat gradually if pos- 
sible. At first but one bottle a day is given, the child 
being nursed at its other meals, but as time goes on the 
number of bottles given is gradually increased while the 
frequency of suckling is correspondingly diminished, 
until by the time about a month has elapsed the breast 
has been withdrawn entirely. This plan gives the child 
time to become accustomed to its new diet, which should 
consist of a milk-mixture as much like woman's milk as 
possible. The formula on page 135 may conveniently be 
followed. 

Sometimes it is necessary to wean rapidly. One of the 
chief causes of this is the refusal of the baby to take the 
bottle at all. Patience and persistence will generally 
overcome this, or it may be that the child will take food 
from a spoon or a cup. Should it still refuse, the only 
way open is to withdraw the breast entirely and at once 
until hunger forces it to eat. With sudden weaning, or 
sometimes even with the gradual process, the mother has 
much trouble from the distention of her breasts with 
milk, and must employ care lest an abscess result. She 
should take as little liquid of any kind as possible, 
whether water, tea, soup, milk, or whatever it may be. 
She should also take a gentle purgative, such as citrate 
of magnesia or a mineral water, keep the breasts sup- 
ported by a broad band going beneath them and over the 



120 THE CARE OF THE BABY. 

shoulders, partially empty them occasionally with the 
breast-pump if the distention is painful, and prevent 
caking by diligently rubbing them with warm oil. Any 
other treatment, such as the application of ointments, had 
better be left to the family physician. 

Karly weaning may be rendered necessar}^ in differ- 
ent ways. If the mother is suffering from the drain of 
nursing or from great debility, consumption, or other 
exhausting ailment, or if she develop any severe acute 
disease, such as typhoid fever, pneumonia, or the like, 
nursing the child is quite out of the question. It is 
very commonly believed that the return of the menstrual 
period makes nursing improper. Although this occur- 
rence very often does render the milk unfit for the child, 
yet this is not an invariable rule, and the mother should 
do nothing precipitately in the matter. After the occur- 
rence of one monthly period there may be no reappear- 
ance of it for several months, and weaning would have 
been entirely unnecessary. Each case is a rule to itself, 
and onl}' the effect upon the mother and baby can settle 
the question, even if the periods have returned regularly. 

Should the mother become pregnant again, the child 
should be weaned, for it is too great a drain upon her to 
sustain both the one present and the one to come. 

Sometimes there is a great falling ofif in the quantity 
or qualit}' of the milk, which cannot be remedied in any 
way, or there may be an entire and even early cessation 
of the flow. Again, the breast-milk may be richer than 
the child can digest. Sometimes excessively painful 
fissures occurring in both breasts and refusing to heal, 
or the persistence of obstinately retracted nipples, may 
render nursing impossible, even with the aid of an arti- 
ficial nipple. Abscess of the breast prohibits nursing 
from the one that is affected. 



FEEDING THE BABY. 121 

Before breast-feeding is abandoned on account of any 
defect in the amount or quality of the milk the mother 
should not fail to make sure that the trouble really exists, 
and that it cannot be remedied. The only accurate 
method of determining the character of the milk is, of 
course, to have a chemical analysis made of it. But even 
without this the mother may be able to form some idea 
of the nature of the difficulty. This is to be done partly 
by observation of the baby, partly by direct study of the 
milk with the aid of a creamometer and a specific gravity 
apparatus, such as are described and their employment 
explained on page 132. Those for use with human milk 
are usually made especially small, in order that less milk 
sliall be required. 

First, then, we must remember that if a baby is grow- 
ing at the proper rate, it is getting enough to eat. Any 
crying is probably due to some other cause than hunger, 
even although the child may not seem satisfied. If, 
however, it is not growing properly, and there is no 
diarrhcea, or vomiting, or other ailment to account for 
this, it is probable that the milk either is not rich enough, 
or that it is insufficient in amount. If the child tugs 
long and hungrily at the breast, and is unwilling to 
cease sucking after it should have finished, or if, perhaps, 
after a period of nursing, it drops the nipple with a dis- 
satisfied cry, it is ver}' likely that the milk is insufficient 
in quantity. This is particularly so if the breasts are 
flabby before nursing and seem to be quite empty after it. 
If, on the other hand, the milk is bluish and pale even 
though very abundant, and if the child seems tempo- 
rarily satisfied after nursing and the breasts are not 
emptied, it is probable that the richness of the milk is 
deficient. 

By looking at the analytical table on page 129 we see 



122 THE CARE OF THE BABY. 

the ingredients of which milk consists. It is the fat and 
the albuminoids which are the ones especially liable to 
vary in quantity. The amount of sugar may be ignored 
at present, as it is less variable. Milk deficient in rich- 
ness may lack the proper proportion of either or both of 
these two ingredients. Which of them is at fault we can 
determine to some degree by direct study of the milk. 
In getting the milk for examination the baby should be 
allowed to nurse for a couple of minutes, the nipple 
should then be washed and dried carefully, and a por- 
tion (about one or two tablespoonfuls) should then be 
drawn by the breast-pump. The milk thus obtained 
represents about the middle of the nursing. 

Average human milk should separate in the cream- 
ometer about 7 per cent, of cream, which is equivalent 
to about 4 per cent, of fat. By determining the percentage 
of cream with this instrument and comparing it with the 
specific gravity we can, as we shall see presently, esti- 
mate the amount of albuminoids present, and decide 
whether the lack of richness is in fat or in albuminoids, 
or in both (see Table, page 123). 

But very often the necessity of weaning threatens on 
account of an excess of richness of the milk. An excess 
in the actual quantity of the milk may show itself by re- 
gurgitation (see pages 113 and 250) and often by the 
presence of large quantities of curds in the stools. This 
excess is generally easily controlled by removing the 
child from the breast before it has taken too much, or by 
compressing the nipple during the nursing in order to 
make the milk flow more slowly. Too great richness of 
the milk is not so easily managed. If there is too much 
fat present, there may be a tendency to vomit rancid- 
smelling material, or to suffer from diarrhoea. The test 
with the creamometer will show the actual amount of 



FEEDING THE BABY. 



123 



cream. By far the more frequent and troublesome fault, 
however, is an excess of the albuminoids. This usually 
shows itself by vomiting of curdy material, or, still 
oftener, by the constant presence of a large amount of 
white, curdy lumps in the stools. Except by the ex- 
amination of the milk, this condition can scarcely be dis- 
tinguished from the disordered stools dependent upon an 
excessive quantity of milk taken. Colic, too, is ver)' 
common, and all the symptoms of indigestion may finally 
grow so prominent that weaning may seem necessary. 
Again, by the use of the creamometer we may determine 
the amount of cream present, and then, by comparing 
this with the specific gravity we can judge whether the 
albuminoids are in excess. 

The following very useful table has been devised 
(Holt), by consulting which the mother may be aided in 
making, with a little practice, an approximate analysis 
of her breast-milk. The procedure is quite simple. If 
the specific gravity and the cream-percentage of any 
sample of breast-milk are obtained, and the two com- 
pared as found in the second and third columns of the 
table, the amount of albuminoids corresponding to these 
will be shown in the fourth column. At the same time 
it is certainly better, as a rule, to leave this analysis to 
some one experienced in such matters. 

Approximate Analysis of Breast-milk. 



Specific Gravity. ' 
70° Fahr. I 



Cream, Twenty-four 
Hours. 



Average. 

Normal variations. 



Abnormal 



Albuminoids. 



1031. 7 per cent. 1.5 per cent. 

1028-1029. 8-12 per cent. 'Normal (rich milk). 

1032-1033. 5-6 per cent. " (fair milk). 

Low (below 1028). j High (above 10 percent.).' " or slightly below 

" " " Normal (5-10 per cent ). Low (poor milk). 

" " " Low (below 5 per cent.), 

High (above 1033). High. 

" " " Normal. 

" " " Low. 



Very low (ver^' poor milk). 
I " high(very rich milk). 



High (rich milk). 
Normal, or nearly so. 



124 THE CARE OF THE BABY. 

Supposing, now, that we have found some defect in 
the quantity or quality of the breast-milk. The ques- 
tion arising is whether something cannot be done to cor- 
rect this, instead of at once subjecting the baby to the 
trials of artificial feeding. Modification of the amount or 
kind of food taken, and of the method of living and the 
frequency of nursing, exerts a powerful influence upon 
the composition of the milk. Consequently much may 
often be accomplished by following certain rules, which 
are formulated in the following table (Rotch). 

Rules for Modifying Breast-milk. 

^ . ^, ^ ^ , ^.^ ( Increase the liquids in the 

To increase the total quantity . { ,. 

„ , ^, ^ ^ 1 ^.^ ( Decrease the liquids in the 

To decrease the total quantity . j , . ^ 

r Shorten nursing-inter\^als ; de- 
To increase the total solids . . \ crease exercise ; decrease 



••[ 



the Hquids in the diet. 
Lengthen nursing-intervals ; in- 
To decrease the total solids . . \ crease exercise ; increase 



the liquids in the diet. 

To increase the fat Increase the meat in the diet. 

To decrease the fat Decrease the meat in the diet. 

To increase the albuminoids . Decrease the exercise. 

Increase the exercise to the 



To decrease the albuminoids 



limit of fatio^ue 



Should the mother still find it necessary to abandon 
nursing, she does not necessarily have to wean the baby, 
since she may employ a wet-nurse. There is no question 
that the milk of a good wet-nurse is very greatly to 
be preferred to bottle-feeding. At the same time there 
are many and weighty objections to the employment of 
a wet-nurse. Not only is it ver>' difiicult to obtain one 
who even seems likely to be suitable, but the position of 



FEEDING THE BABY. 12$ 

the nurse at once makes her the tyrant of the household. 
She frequently proves to be altogether unreliable, will not 
take the care of herself which is necessary to the preser- 
vation of the quality of her milk, and at any moment 
may become dissatisfied and abandon her position, per- 
haps leaving the last state of the baby considerably 
worse than the first. Nevertheless, in the case of a deli- 
cate child or the failure of artificial food to agree, the 
employment of a wet-nurse often is the baby's only 
chance for life. The selection of a wet-nurse we can 
best discuss when considering the subject of The Baby's 
Nurses, in Chapter IX. 

This brings us to the consideration of the very compli- 
cated subject of artificial feedings often one of the most 
perplexing problems which can present itself to the com- 
bined study of mother and physician. In the effort to 
solve it too careful attention cannot be paid to the 
smallest and apparently most trifling details, for, although 
many a baby seems to have a totally insensitive stom- 
ach and will thrive on nearly anything, many another 
cannot keep in health unless the food suits it exactly. 
In endeavoring to feed a baby properly we must bear in 
mind three important factors, already referred to to some 
extent in discussing the means of modifying the breast- 
milk: 

(i) The quantity of the food; 

(2) The quality of the food; 

(3) The individual peculiarities of the child. 

(i) The Quantity of the Food. — One of the most fre- 
quent mistakes made in feeding a baby is that of giving 
it a much greater quantity of food than it can possibly 
assimilate, with the result that it either vomits it or 
passes it through the bowels in an indigested state. A 
new-born baby's stomach holds without distention only 



126 THE CARE OF THE BABY. 

about one ounce (two tablespoonfuls) or less. The ac- 
companying illustration (Fig. 30) represents the actual 
size of the stomach at birth. It shows perhaps better 
than in any other way how small the infant stomach 
really is. How foolish, then, to feed a new-born child 




Fig. 30. — Stomach of infant at birth (natural size). 

from a full-sized nursing bottle, and to allow it to gorge 
itself with all it will take! Careful study of the size of 
the stomach at different ages in infancy, and of the 
quantity of milk drawn from the breast by a nursing 
baby, has led to pretty uniform conclusions among physi- 
cians regarding the amount of nourishment which may 
be suitably given to a child at dififerent periods of its 
life. The accompanying table, taken with slight modifi- 
cations from an excellent article by Dr. Rotch, shows the 
amount proper at each feeding, the number of feedings, 
and the total quantity required in twenty-four hours. 
As has been stated in a previous chapter, this and the 
following tables apply as well to children who are fed at 
the breast, and may be taken as a guide for the frequency 
of and hours for nursing them. 



FEEDING THE BABY. 

General Rules for Feeding. 



127 



Age. 


Intervals of 
feedings. 


Number of 
feedings in 
24 hours. 


Average 

amount at 

each feeding. 


Average 
amount in 
24 hours. 


ist week . . 


2 hrs. 10 


lOZ. 


lOOZ. 


1-6 weeks . 


2>^ hrs. 


8 


I>^-2 OZ. 


12-16 OZ. 


6-12 weeks, 
and possi- 
bly to 5th or 
6th month 


V3hrs. 


6 or 7 


3-4 OZ. 


18-24 OZ- 


6 months . . 


3 hrs. 


6 


60Z. 


36 OZ. 


10 months . 


3>^-4 hrs. 


5 


80Z. 


40 OZ. 



Thi.s table is intended to apply only to children of the 
normal lengths and weights corresponding to their ages, 
and is, like all rules, subject to exceptions. It is very 
important that the .size of a child be constantly borne in 
mind, since it is often more of a criterion than the age. 
It is manifestly absurd to expect a baby twice as large as 
another of the same age to be contented with the amount 
of food which .sati.sfies the smaller one. When, there- 
fore, a baby has largely fallen behind in gro\vth, we must 
often ignore its age to a great extent, and give to it an 
amount of nourishment not much in excess of that suit- 
able to the age to which its actual size and weight cor- 
respond. This age may be determined by consulting the 
table on page 52. On the other hand, some children take 
and digest much more food than others of equal age and 
equal size. In such cases it is safe to exceed the amount 
given in the table if we are quite sure the food is being 
digested. 

The following table gives in convenient form the hours 
for feeding a child under one year of age, whether on the 
bottle or at the breast. It is made to correspond, as far 
as possible, with the table just given, and is so arranged 



128 



THE CARE OF THE BABY. 



that feeding does not interfere with the hours for the 
morning and afternoon naps. 

Hours for Feeding. 



ist week. 


I week to 
6 weeks. 


6 weeks to 
4 months. 


4 to 8 
months. 


8 to 12 
months. 


7 A.M. 


7 A.M. 


7 A.M. 


7 A.M. 


7 A.M. 


9 " 
II " 


9-30 " 

12 M. 


10 " 
I P.M. 


10 " 
I P.M. 


10.30 " 
2 P.M. 


I P.M. 

3 " 

5 " 
7 " 
9 " 

12 " 


2.30 P.M. 

5 

7.30 " 

10 

3 A.M. 


4 " 

7 *' 
10 " 

3 A.M. 


4 " 

7 " 

10 " 


6 " 
10 " 


4 A.M. 











This table, like the preceding, is of course intended 
only as a guide, not as a hard-and-fast rule. It is open 
to modification depending upon various factors. Some 
children with healthy appetites do not require or desire 
nursing so frequently. In some cases it is frequently 
necessary and advisable to waken the child at the ap- 
pointed hours for feeding. In other cases we may ad- 
vantageously make a different schedule if wakening often 
has to be done. Again, if a child wakens hungr\^ every 
night at a time different from that given in the table, it 
is better to feed it then than to allow it to rouse itself 
thoroughly by crying. In other cases the frequency of 
nursing cannot be diminished so early as the table gives 
for the different ages. 

(2) The Quality of the Food. — Regarding the char- 
acter of food to be given to a child — that is, its quality — 
it is evident that the more closely the food resembles 
mother's milk the more likely it is to agree with the 
child. It is a common custom to alter the composition 
of the artificially-prepared milk according to the increas- 
ing age of the child. To make this a routine procedure, 



FEEDING THE BABY. 



129 



in the case of healthy and flourishing babies, is unneces- 
sary and harmful. The mother's milk, if it keeps of 
good quality, does not vary very materially during the 
many months of suckling, and there is consequently no 
reason for any change in the composition of the artificial 
food if we can once get it to simulate human milk and 
to be well digested. Of course, if a child ceases to 
grow properly, an increase in the strength of the food 
may be needed. Ass's and mare's milk is considerably 
closer in composition to woman's milk than is that of 
other domestic animals. That of the goat is somewhat 
more like it than is that of the cow. It is rare, however, 
that either of the first two milks can be obtained, and 
they are apt to be expensive; and since all of them need 
in any case to be prepared in various ways before using, 
cow's milk becomes the only baby's food usually practi- 
cable. That it is, however, much unlike woman's milk 
in some particulars can be seen by consulting the fol- 
lowing table (Rotch), which gives approximate analyses 
of the two fluids. 



Woman's Milk. 


Cow's Milk. 


Reaction 


. Alkaline 


Reaction 


. Acid. 


Bacteria 


. None 


Bacteria 


. Present. 


Water 


. 87-88% 


Water 


. 86-87% 


Total soHds .... 


. 12-13% 


Total solids . . 


• 13-14% 


Fat 


.4% 


Fat 


.4% 


Albuminoids .... 


. 1% 


Albuminoids .... 


.4% 


Milk-sugar 


.7% 


Milk-sugar 


.4.5% 


Ash 


. 0.2% 


Ash 


. 0.7% 



Besides these characteristics, woman's milk has a 

specific gravity of about 1031, while cow's milk has that 

of about 1029. Cow's milk is, as the table shows, slightly 

acid in reaction in the condition in which it is served by 

the milkman. As drawn from the cow it ought to be 
9 



130 THE CARE OF THE BABY. 

alkaline, but very quickly becomes acid, owing to faults 
in the milking. When we consult the table we are 
struck by the fact that woman's milk has the same per- 
centage of fat as cow's milk, that it is almost twice as 
rich in sugar, and that it has only one-quarter as much 
of the ' ' albuminoids. ' ' By this last term are desig- 
nated those portions of the milk upon which the produc- 
tion of new tissue in the baby largely depends. Among 
these is the casein of the milk — namely, the part which 
forms the curd. This casein is particularly abundant in 
cow's milk, and it is this ingredient especially which 
renders the pure milk of the cow unfit for the baby. 
Now, if we dilute cow's milk with water sufficiently 
to render the percentage of albuminoids identical with 
that of human milk, we shall meantime lower the 
amount of sugar and of fat, and the milk will be very 
imperfect in these particulars. The only method by 
which to overcome the difficulty is to make up the de- 
ficiency after dilution by adding more cream and sugar. 
Besides this, we must add to the mixture a small quantity 
of an alkali, such as bicarbonate of soda, or lime-water, 
in order to take away the slight acidity. 

Another characteristic of cow's milk is the fact that 
the curd which forms in it is much tougher and firmer 
than that which is seen in woman's milk. This may be 
due to some chemical peculiarity of the casein, but it 
seems more likely to be dependent chiefly upon the 
greater amount of it present, since a sufficient dilution 
renders the curd identical in appearance with that of 
human milk. Undoubtedly there do exist distinct differ- 
ences of some sort between the albuminoids of woman's 
milk and of cow's milk. 

It has been claimed, too, that boiling causes the form- 
ation of a tougher curd, and it is certain that it does alter 



FEEDING THE BABY. I3I 

the milk in some way which may render it rather more 
difficult to digest. 

Although there are numbers of infant's foods on the 
market, as a rule by far the safest and most accurate sub- 
stitute for mother's milk can be prepared at home. To 
make the mixture properly it is of primary importance that 
the several ingredients themselves be of proper quality. 
The cow's milk should be unskimmed and should be pro- 
cured from a reliable dealer whose cows are healthy and 
carefully kept, and are not fed upon swill or other refuse 
material. It is of no advantage to have the milk from a 
single cow; it is, in fact, of distinct disadvantage, for the 
great difference which exists between the milk of differ- 
ent cows makes it impossible to prepare a proper imita- 
tion of mother's milk according to any fixed rules unless 
we should have the individual cow's milk analyzed in 
order to determine in just what way the mixture should 
be made. Besides this, the milk of any cow is subject to 
variations from time to time, depending upon the nature 
of the food given it, the health of the animal, and other 
factors. It is therefore preferable to use mixed herd milk 
— not solely Aldemey, which is too rich — since this gives 
a much more uniform basis for the food. 

Every possible precaution should be taken to ensure 
absolute cleanliness of the udder, the milk pail, and the 
hands during milking, and the milk should then be 
cooled rapidly and at once scaled in jars. We can judge 
to a large extent of the quality of the milk by its appear- 
ance. It should be of a yellowish- white color, without 
any bluish tinge. To determine still more accurately 
its quality an instrument called a lactometer is employed, 
although the simplest apparatus is the urinometer, used 
by physicians for testing urine. This latter apparatus, 
which may be procured through any druggist, consists 



32 



THE CARE OF THE BABY. 



I 



of a small glass cylindrical tube and a specific-gravity 

glass, as shown in the illustration (Fig. 31). The tube 

should be partially filled with milk of the 

^P=^ usual room-temperature (70° F.) and the 

glass be floated in it. The specific gravity 

of the milk — that is, its density 

as compared with water — may 

then be read off on the scale 

on the stem of the apparatus. 

The average density of cow's 

milk is 1029, water being called 

li ; 1000. The apparatus is only 

of limited value, for milk 

which is very poor may give 

F1G.31.— Urin- j-es^its similar to that which is fig ^2- 

ometer. • i * n i ^ 

very rich. All that we can say Creamometer. 
here is that if the specific gravity is less than 1028 or 
more than 1035, the milk is suspicious. Of course, even 
a normal specific gravity, taken by itself, is not proof 
that the milk is good. 

So, too, there is no accurate instrument for household 
use which shows the richness of the milk in cream. An 
inexpensive apparatus called a crcaviometer or cream 
gauge is sold in the instrument-shops and is often recom- 
mended. It consists of a cylindrical tube, all or the 
upper part of which is graduated. The milk is allowed 
to stand in this, carefully corked, for twenty-four hours, 
at about 70° Fahr., until the cream rises, and the thick- 
ness of the layer of the latter is then read off on the scale 
(Fig. 32). Theoretically, the cream in the apparatus 
should measure ^ or y^ of the total height of the column. 
The trouble with the creamometer, however, is that some 
milk, even though rich, parts with the cream ver\- slowly 
and imperfectly, while some poor milk allows nearlv all 



PEEDIKG THE BABY. 1^3 

of it to go to the surface. The results with the appa- 
ratus are consequently very misleading, for the poor milk 
may seem to have more cream than the rich. I know, in 
fact, of no way for the mother to determine the amount 
of cream except roughly by the color and richness in ap- 
pearance of the milk. Where the milk seems even sus- 
picious the milkman should be changed. In cities it is 
easy to have an analysis of the milk made by a chemist. 
The use of the creamometer for testing human milk is 
rather more satisfactory. It has already been described 
on page 122. 

There is one test which we can always apply — namely, 
that for acidity. A strip of blue litmus-paper dipped part 
way into the milk will turn faintly red if it is acid, as it 
nearly always is when delivered by the milkman. The 
milk should be put in the tube of the urinometer, and 
the paper examined through the glass while still in the 
milk. If, after the mixture with soda-solution or lime- 
water and the sterilizing, presently to be described, we 
again find that blue litmus-paper turns red, we know that 
the milk is becoming sour and is unfit for use. 

Milk is often artificially colored to give it a rich creamy 
appearance. The substance oftenest used for this purpose 
is annatto. It may be detected by mixing a pinch of 
baking-soda with a couple of tablespoonfuls of the milk, 
inserting one-half of a strip of filter-paper in the fluid, 
and allowing it to remain over night. Annatto will give 
a distinct orange tint to the immersed paper. 

The choice of the cream which is to be added in mak- 
ing the baby's food is of importance, since it varies 
greatly in richness. To be accurate a chemical analysis 
is needed. For practical purposes it is chiefly important 
to consider how the cream is obtained — whether by skim- 
ming or by a centrifugal machine such as is used in the 



134 '^HE CARE 02^ THE BABY.- 

large dairies. The thinner centrifugal cream, about as 
thin as a machine makes it, is to be preferred. It con- 
tains 20 per cent, of fat, while the average cream obtained 
by skimming possesses only about 16 per cent, of fat. It 
is better to obtain the centrifugal cream when possible, 
as its richness is more uniform, and, besides this, it is not 
so apt to have undergone changes as a result of the long 
standing to which ordinary cream is subjected. When 
skimmed cream must be used, instructions should be 
given to the. dairyman that the milk stand always the 
same number of hours, and at the same temperature, 
before skimming, and that it always be skimmed by the 
same person. The amount of cream used in preparing 
the bottle will depend entirely upon its percentage of fat, 
since the richer it is the less, of course, will be required. 
Very often the quantity can be determined solely by 
experience in feeding the child. As in the case of milk, 
it is better that the cream come from a herd rather than 
from one cow. 

Although ordinary sugar (cane-sugar) may be used to 
sweeten the baby's food, it is better to employ milk-sugar, 
since this is the variety naturally present in milk. Cane- 
sugar answers just as well for sweetening, but it is prob- 
able that the milk-sugar serves some other purpose than 
this merely. Should it be desired for any reason to 
use cane-sugar, it is important to remember that it has 
several times the sweetening power of milk-sugar, and 
must therefore be used in a considerably smaller amount. 

Some physicians recommend that a pinch of salt be 
added to the mixture in order to make up for the amount 
naturally in the milk before the dilution. The addition 
certainly does no harm, although it is not an essential. 

We are now ready to examine the methods of mixing 
our ingredients in order to produce the correct artificial 



FEEDING THE BABY. 1 35 

human milk. Various mixtures have been described, but 
many of them are only poor imitations. A very good 
one is that proposed by Dr. A. V. IMeigs (Appendix, i). 
Artificial human milk prepared according to this formula 
approaches very closely to the character of natural milk. 
It is, however, much more alkaline than necessary, and 
the taste of the lime-water is evident. Moreover, the 
sugar-water used in it must be made fresh every day or 
two, as it will spoil. 

The use of lime-water (Appendix, 22) in milk mixtures 
decidedly complicates the process of sterilizing at a high 
temperature, as we shall see presently. As the sole value 
of the lime is to render the preparation alkaline, bicar- 
bonate of soda (baking-soda) should be used where steril- 
ization is to be employed, since it answers this purpose 
just as well and is just as healthful for the baby. The 
following mixture is easy to prepare: 

Formula for Milk Mixture. 

Milk I oz. ; 

Cream, centrifugal (20 per cent, fat) . . lYz oz.; 

or 
Cream, skimmed {16 per cent, fat) ... 2 oz. ; 

Lime-water or soda-solution K oz. ; 

Milk-sugar i measure; 

Water, enough to make 8 oz. 

The amount of cream varies with its richness, as indicated 
in the formula. The soda-solution is of the strength of i 
grain of bicarbonate of soda in a half ounce of water. 
It will keep indefinitely. A half dozen or more packages, 
each containing i drachm of soda, may be obtained from 
a druggist at small cost. One of these dissolved in a 
quart of water forms a solution of the proper strength, 
one tablespoonful of it equalling in alkalinity one table- 



136 THE CARE OP THE BABY. 

Spoonful of lime-water. It should be kept in a bottle, 
well corked. 

To save expense the milk-sugar should be bought sev- 
eral pounds at a time, and from a wholesale druggist. 
The required amount may be measured out as needed. 
A Philadelphia drug firm (A. Blair & Co.) has made at 
my suggestion a small tin measure (Fig. 33) somewhat 
different in shape from the one devised by Dr. Rotch, and 
holding 3f drachms of milk-sugar — the quantity required 
for eight ounces of the milk mixture. The measure 
should be filled by scooping up the sugar out of its box 
and pressing it gently against the box's side with a force 
which is as nearly as possible the same on all occasions. 
Of course, in this and in other formulae given we may 




=^^ 



^^^' 33- — Sugar-measure. 



dissolve the measure of sugar in the water, thus making 
a sugar-water. This is sometimes convenient when we 
wish to make somewhat more or less than the eight 
ounces of 'milk mixture. 

It is often a difficult matter to procure a satisfactory 
cream. We may then, in place of the formula recom- 
mended, use one in which "/<:?/- ?^/ ///&," as it is called, is 
employed. This is obtained as follows: Have made a 
syphon — a U-shaped tube — from a piece of glass tubing, 
letting the short arm be about eight inches long and 
the long arm about twice this. Procure in the morn- 
ing one quart of milk, place it in a cylindrical glass jar, 
such as a preserve-jar, screw its lid on tightly, place on 
ice, and allow it to stand for six hours. At the end of 
this time remove the jar carefully without shaking, fill 



PEED INC THE BABY. I37 

the syphou with boiled water, insert the short arm gently 
down to the bottom of the jar, and syphon off all but six 
ounces of the milk. This remaining top-milk is really a 
thin cream, and we may use it in the following formula, 
which makes a mixture a trifle weaker than that in the 
formula just given. 

Top-milk Mixture. 

Top-milk 2 oz.; 

Lime-water or soda-solution '2 oz. ; 

Milk-sugar i measure; 

Water, enough to make S oz. 



The jar, lid, syphon, and bottles should be washed or, 
preferably, boiled, daily before using. A line may be 
filed on the jar, showing the level at which six ounces 
still remain in it. This is a convenience in syphoning. 

We must remember that by no means every baby can 
start upon a milk mixture as strong as the ones just given, 
although these represent the strength of human milk. 
If they disagree, they must be abandoned at once, and 
some other mixture of different proportions tried. Of 
recent years physicians have been accustoming them- 
selves more and more to the calculation of various for- 
mulae to suit individual cases, basing these upon accurate 
estimated percentages of fat, albuminoids, and sugar, 
rather than upon a mere guessing at the number of tea- 
spoons or tablespoons or ounces of milk and cream which 
may seem to be needed. But to do this is certainly 
beyond the power of any mother untrained in such 
matters. It is to be strongly urged, therefore, that in 
every case where a certain milk mixture disagrees with a 
child the proper calculation of another formula be re- 
ferred at once to the family physician. 

Having determined the proper ingredients and tlieit 



138 THE CARE OF THE BABV. 

amounts, the next thing to do is to put them together in 
the proper manner. The subject of sterilization is an im- 
portant one in this connection. Mother's milk as drawn 
from the breast has been found to be entirely or nearly free 
from those microscopic germs of decomposition which are 
the cause of souring. Cow's milk as it comes from the 
udder should be equally free, but through lack of cleanli- 
ness in milking, or even by exposure to the air during 
the delay which must necessarily occur before it reaches 
the baby, it becomes infected with quite enough of the 
germs to produce the poisonous changes which have 
killed so many infants. The fact that milk appears per- 
fectly sweet is no criterion, for if the germs are already 
in it the harmful changes may take place even after the 
baby has had its meal. As it is generally impossible to 
procure cow's milk sufficiently free from the germs, the 
only method is to sterilize the milk — that is, to kill the 
germs. There are various means which may be employed 
for accomplishing this end, all of them depending upon 
the fact that a temperature equalling that of boiling water, 
or even less, if applied sufficiently long, will prevent sour- 
ing, and will also kill any germs of such diseases as t>'- 
phoid fever, diphtheria, and the like which may chance 
to be present. The milk mixture may be boiled in a 
vessel immediately before using, or it may be placed in 
bottles and those surrounded by boiling water, or steamed 
in a farina kettle for three-quarters of an hour. The objec- 
tions to actually boiling the milk are that it gives it an 
unpleasant taste, and probably affects its chemical char- 
acter in a such a way that it becomes less digestible than 
before. It is also very troublesome, because it must be 
done at each feeding. The other methods are crude and 
not very satisfactory'. It is far better, therefore, to pro- 
cure at once a special apparatus for sterilizing, since its 



FEEDING THE BABY. 1 39 

initial cost is small and it will save a world of trouble 
in the end. It should be almost as much of a necessity 
in the household as are the baby's clothes. 

The great principle of all sterilizing is, first, the killing 
of germs present in the milk, and, second, the prevent- 
ing of other germs from entering into it later. If both 
these ends are fully met, the milk will keep sweet for 
months or even years. Such perfect preparation is, how- 
ever, seldom attained and is not necessary. 

There are two classes of apparatus used to accomplish 
the destruction of the germs: one, known as a sterilizer, 
which sterilizes the milk at a boiling temperature (212° 
F.); the other, called a Pasteurizer, which is really a 
modified sterilizer, killing the germs at a much lower 
temperature. Of recent years the latter has become 
much the more popular. Of the sterilizer, various forms 
have been devised, but one of the best is that known as 
Arnold's. This apparatus is provided with eight bottles, 
each holding a little over seven ounces, and marked 
on the glass. with a graduated scale of ounces, by 
means of which the amount of nourishment poured into 
them can readily be measured (Fig. 34). 

The method, then, in detail for preparing the baby^s 
food, including the use of the sterilizer, is as follows: 
As soon as the milk and cream come in the morning, the 
mixture for the entire day should be prepared according 
to one of the formulae on pages 135 and 137. As large a 
quantity should be made as the table on page 127 or the 
experience with the individual child shows will be re- 
quired for the twenty-four hours. The bottles, previously 
thoroughly cleaned, should each be filled with as much 
of the mixture as is required for each feeding. They 
must next have their mouths carefully dried and stopped 
with plugs of raw cotton (not absorbent). They are then 



140 



THE CARE OF THE BABV. 



placed in the rack in the sterilizing chamber and the lid 
and hood are applied. The pan of the sterilizer is now 
filled two-thirds full with water, and the whole is placed 




Fig. 34. — Arnold sterilizer. 



on the hot stove for an hour. About twenty^ minutes of 
this time will be occupied in heating the milk up to the 
high temperature required, and the remainder in keeping 



FEEDING THE BABY. I4I 

it at that point and thus sterilizing it. Raw cotton is 
used as a plug because experience shows that the minute 
germs cannot pass through it. It is best, however, that 
it shall not come into contact with the milk. 

When it is desired to carry the bottles about to any 
extent after sterilizing, it is better to use a rubber cork 
instead of the cotton. In this case the bottles, with the 
corks very loosely in place, are put in the sterilizer for 
about twenty minutes until the liquid and the air con- 
tained is thoroughly heated. The corks are then pushed 
firmly into place and the sterilizing is continued. The 
bottles thus corked may lie afterward in any position. 

Sterilized milk prepared in this way should keep per- 
fectly sweet without being placed on ice. As an addi- 
tional safeguard, however, it is better to keep the bottles 
in a cool place, although this is not needed if the process 
has been properly carried out. We must never forget 
that the cotton plug must not be removed, even for a 
moment, from the time it is first put in place until the 
time for feeding the baby comes. 

Food prepared as described above will keep perfectly 
well for twenty-four hours at least, but in the hottest 
weather it is an additional safeguard to re-heat in the 
evening the bottles which are to be used during the 
night and early morning. 

When milk is to be prepared for use while travel- 
ling, a more thorough sterilization is necessary in 
order to avoid the possibility of any germs being left 
alive. To accomplish this the bottles of milk should be 
subjected to sterilization upon one day, again upon the 
second, and then again upon the third. 

The disadvantage of using lime-water in preparing the 
milk mixture becomes evident in sterilizing. Not only 
does the lime combine in some way with the sugar and 



142 THE CARE OF THE BABY. 

produce a brownish color, but it is largely precipitated by 
boiling, and the lime-water is thus destroyed. We can, 
of course, obviate this by adding the lime-water to each 
bottle just before feeding the baby, but it becomes rather 
a complicated matter to calculate just what quantity of 
it is required with the gradually increasing amounts of 
nourishment which the baby demands. The use of soda- 
solution instead of lime-water allows us to complete the 
mixture at the outset. 

As already stated, it seems certain that the boiling of 
milk, or even the sterilizing of it in the manner de- 
scribed, lessens its digestibil- 
ity to a cousiderable extent. 
On this account Pasteuriza- 
tion is much to be preferred, 
and is, indeed, the method 
now approved by most physi- 
cians. The process, as we 
have seen, is only a modified 
sterilizing. It was devised 
Fia^T^TlFV^an's Pasteurizer. by the celebrated French 

chemist Pasteur, and first 
employed in the manufacture of wine. As applied to 
milk it consists in heating the bottles containing the 
milk mixture to a temperature of 155° or 167° F. instead 
of to 212°, as in ordinary sterilizing, and in then remov- 
ing them to the refrigerator just as soon as they will 
stand the cold. It has been found that this process 
destroys the germs sufficiently for practical purposes, and 
that it does not alter the digestibility of the milk or affect 
its taste. 

Of the devices for Pasteurizing, that most to be rec- 
ommended is the Freeman Pasteurizer (Fig. 35). This 
consists of a metal pail into which fits a rack holding 




FEEDING THE BABY. 1 43 

the bottles, much as in the sterilizer. The pail is partly 
filled with water, heated to boiling on the stove, and then 
removed. The rack with bottles, prepared as for steriliz- 
ing, is then placed in it, the lid applied, and the whole 
allowed to stand on a table for forty-five minutes. The 
exact quantity of water required has been accurately 
calculated by the inventor. The scientific principle 
involved is that while this amount of water cools, the 
milk in the bottles grows warm, until both soon reach 
the desired temperature. After the forty-five minutes 
have elapsed water from a spigot is turned into the pail 
in order to cool the bottles rapidly, and these are then 
kept upon ice. This keeping on ice is important, as 
Pasteurized milk requires rather more care to preserve it 
than sterilized milk does. The use of the apparatus is 
very simple, its cost is small, and one should certainly 
be procured whenever a child has to be fed artificially. 
It is perfectly possible to Pasteurize in other ways, but 
the process is troublesome, for to obtain satisfactory re- 
sults the temperature must be exact. We may, for in- 
stance, use the Arnold sterilizer, leaving the hood off" and 
setting the lid ajar, and continuing the heating for forty- 
five minutes. But to be sure that we are obtaining the 
correct temperature it is necessary to have a special ther- 
mometer in one of the bottles and to watch this con- 
stantly. So, too, it has been proposed to place the 
bottles of milk in a dishpan or large saucepan of water, 
preferably with an inverted tin pieplate with holes 
punched in it laid inside as a false bottom, and to heat 
fliis until the thermometer in the water reaches 170° F. 
The pan should then be removed from the stove, covered 
with an old blanket, and allowed to stand forty-five 
minutes. But here, too, the troublesome use of a ther- 
mometer is required, and after the pan is removed from 



144 I'HE CARE OF THE BABY. 

the stove we do not know at all what temperature the 
milk actually maintains. The results cannot be accu- 
rate. 

Indeed, Pasteurization, though so simple and secure 
with a Pasteurizer, is not a safe and easy process with any 
makeshift, and all such should be avoided. It is much 
better to sterilize outright than to do imperfect Pasteur- 
ization. 

A few words must be said about the articles required 
for feeding the baby with the artificially prepared food, 
and the method of doing this. It is usually unnecessary 
to have any special nursing-bottle, for the ordinary bottle 
used in the Pasteurizer answers for nursing as well. 
When the time for giving nourishment conies this bottle 
containing the prepared milk should have the cotton 
plug removed and be fitted with a rubber nipple, and 
then be set in a cup of water, which should be heated 
until the contents of the bottle are at a temperature not 
exceeding 95° to 100°. 

Since the baby is apt to wake hungry and impatient 
in the night, it is well to be able to heat its milk quickly. 
A small, narrow, cylindrical tin vessel, tall enough to hold 
the bottle and to cover it with water to the neck onh', 
about three inches in diameter, and with a perforated 
false bottom, answers the purpose admirably. Such a 
vessel, placed on an alcohol pocket stove, or similar heat- 
ing apparatus, will take but a very short time to bring 
the milk to the proper temperature, whereas a receptacle 
holding a large quantity of water will take much longer. 
Any tinsmith can make a vessel of this sort, or it may be 
purchased from the agencies of the Walker-Gordon IMilk 
Laboratory in many of our cities. ]\Iany mothers en- 
deavor to heat the baby's food by putting the bottle con- 
taining it directly into hot water. This is a bad plan, as 



FEEDING THE BABY. 1 45 

it is enough to crack the glass. Heating gradually in 
the way described takes very little longer. 

In giving the bottle the child should be laid upon the 
lap, or should be held in the arms much as in the posi- 
tion for nursing from the left breast. The bottle should 
be held in the hand and its position be so changed from 
time to time that its neck is always full of milk. The 
baby requires ten or more minutes to finish its meal. If 
the rubber collapses, or if the milk does not flow freely, 
the edge of the nipple should occasionally be lifted from 
the neck of the bottle for a moment and a little air 
allowed to enter. It is well in any case to withdraw the 
nipple from the child's mouth now and then to permit 
of a moment's rest or to allow air to enter the bottle. 

When the child has emptied its bottle it must be 
deprived of it immediately. If the bottle has not been 
emptied completely, the remaining contents must be 
thrown out at once. To let the baby continue to suck 
after the bottle is empty is a very bad practice. If the 
baby is allowed to suck at any nipple for the sake of 
quieting it at other times than when fed, it should be one 
of the holeless ones, attached to an ivory disk — a " Com- 
forter," as it is called; but the advisability of permitting 
this is very questionable. 

Bottles employed for feeding should be made very 
smooth inside, without angles and depressions which col- 
lect milk and render cleaning difhcult. Immediately 
after nursing the bottles should be rinsed well and then 
submerged in a strong solution of washing-soda and 
water. They should stand in this until evening, when 
they may be rinsed thoroughlv in pure water, and have 
the interior scrubbed with a bristle brush. It is a good 
plan to boil them also. They may then be placed, in- 
verted, in the sterilizer or elsewhere to drain and dry. 

10 



146 THE CARE OF THE BABY. 

The rubber nipples, of which there should be at least 

two, are preferably of conical shape (Fig. 36). Those of 

black rubber are rather better than those 

/ 1 of white, on account of their greater soft- 

I 1 ness. Most white rubber, too, is said to 

I 1 contain lead. Those nipples should be 

I 11 chosen which have the least odor and 

j 1| taste; as babies sometimes object to this. 

J ll The openings in the end should be large 

^>^^..-*^ enough to allow the milk to pass freely 
Fig. 36.-Rubber ^|^g^ sucked, but should not permit it to 
nipp e. ^^^ ^^^ i's,s\.. When the bottle is inverted 

the milk should drop easily from it. If the holes are not 
of sufficient size, they may be enlarged with a hot pin or 
needle. As the nipple gets older it collapses too easily 
and the holes become too large, and a new nipple must 
be used. There are nipples made with rubber ribs upon 
the inside, the object being to add to the stiflfness and 
prevent collapsing. Others come without holes, in order 
that the mother may make them herself of the size she 
desires. At once after nursing the nipples should be 
scrubbed thoroughly without, and then, by inverting, 
within, with a soft bristle brush, and after this be kept 
submerged in water until needed. Just before using they 
should be dipped for a moment in hot water. The nip- 
ple connected with the bottle by a long rubber or glass 
tube should not be used under any circuifistances. It is 
utterly impossible to keep such a tube clean, and the 
device cannot be sufficiently condemned. Silver nip- 
ples have also been employed to do away with the 
trouble caused by collapsing; but they are very hard 
upon the baby's mouth. 

When there is unusual trouble experienced with the 
collapsing of the nipples, some special method of allow- 



FEEDING THE BABY. 147 

ing the air ingress to the bottle is necessary. There is a 
ventilated nipple on the market which answers the pur- 
pose very well. In it a very small rubber tube connected 
with the outside passes from the side of the nipple into 
the bottle. This nipple is more difficult to keep clean 
than the ordinary form, and, unless unusual precautions 
are taken, some form of ventilated bottle is preferable. 
One of these bottles has a small hole, the size of a pin, 
perforated through its neck close to the nipple. A nar- 
row elastic band, or the edge of the nipple itself, covers 
this, and may be lifted off to admit air when necessar>'. 
Another form of ventilated bottle has an air- valve in the 
bottom. As a rule, however, no special method of allow- 
ing air to enter is needed if the instructions already given 
are followed. In case special nursing-bottles of any kind 
are desired, there should be at least two of them, in order 
that one may have ample time to soak. 

(3) The Individual Peculiarities of the Child. — We 
have to consider finally the third factor in infant feeding 
— namely, the element of idiosyncrasy, which renders 
the nourishment of babies not the simple matter it might 
otherwise be. With all our care the cow's-milk prepara- 
tion cannot be made exactly identical with woman's milk. 
We may arrange to have, for instance, exactly the same 
amount of albuminoids in each, but these albuminoids in 
themselves differ somewhat in chemical character. Conse- 
quently, the milk prepared in the best manner possible 
may not agree. We must then try to find by pure experi- 
ment what food will suit the baby best. It is here that 
the individuality of the child conies in, for, of course, 
what answers for one may not do at all for another. In 
such cases we may try certain of the proprietary infant' s- 
foods on the market, or we may make special mixtures, 
increasing or oftener decreasing the quantity of some one 



148 7UIE CARE OF THE BALY. 

or more of the ingredients of the cow's-milk mixture; 
or we may predigest the food or modify it in some other 
way until we discover something which suits the baby's 
digestion. I cannot too strongly urge that no mother 
make these trials on her own responsibility. The matter 
is too serious for any unskilful experiments, and often is 
exceedingly difficult even for the most experienced 
physician. 

Regarding the numerous patented foods it need only 
be said that some of them are harmful and none of them 
are necessary or desirable for a child with a healthy diges- 
tion. All are made from cow's milk, just as the mixture 
recommended is. Although many of them claim to be "a 
perfect substitute for mother's milk," none of them are 
this, and many contain starch in considerable quantities. 
Others, although utilizing starch, have transformed it 
into dextrin or grape-sugar in the process of manu- 
facture. This procedure certainly presents no advantage 
over, and is in some respects inferior to, the direct addi- 
tion of milk-sugar to the milk in the manner recom- 
mended. The very best of the patent foods are only 
tolerably successful efforts to simulate mother's milk, 
and this is no more than we can do ourselves by fol- 
lowing the formulae given. A mother who wishes to 
feel sure that her baby is getting nourishment upon the 
composition of which she can fairly well depend will 
prepare her own mixture. 

When, however, there exists some individual pecu- 
liarity which renders it advisable that the child be tried 
with one of the foods upon the market, the physician in 
charge, and not the mother or the nurse, should have the 
selection. He will probably choose one which is free 
from starch. The mother can very readily and simply, 
in the following way, satisfy a laudable curiosit}- regard- 



FEEDING THE BABY. 1 49 

ing the presence of starch in any of the foods on the 
market: Dissolve a portion in hot water, add a few drops 
of tincture of iodine to a tablespoon ful of water, mix a 
little of this with the dissolved food, and if starch is 
present a blue color will result. 

There is one form of prepared food on the market 
which is scarcely ever admissible — namely, co)idejised 
7)iilk. When it is diluted sufficiently to make the albu- 
minoids digestible it contains far too little fat; and in 
many cases it is diluted so much that the proportion of 
albuminoids also is much less than it should be. I have 
seen so many babies starving on condensed milk that I 
now rarely give it. It is true that some babies grow fat and 
are seemingly healthy, but the health is often only ap- 
parent, and rickets is very liable to result. If food is 
necessary during the first few days of life, before the se- 
cretion of the breast is established, condensed milk may 
be employed; but even then it offers no special advantage 
over the feeding with diluted cow's milk (see page 135). 
The only other time when condensed milk may be advan- 
tageously used is upon railway journeys and the like, but 
even then it is better to use milk which has been spe- 
cially sterilized, as recommended upon page 141. Con- 
densed milk could, of course, be strengthened by the 
addition of cream before using, and thus made a service- 
able food, but this method presents no advantage over 
that of preparing the food entirely at home in the manner 
already described. 

In place of the commercial foods there are several 
home-mixed milk preparations which experience has 
shown to be of value in some cases of delicate digestion. 
One of these is the gelatin food which was recommended 
by Dr. J. F. Meigs (Appendix, 12). The gelatin and the 
arrowroot in this mixture seem to prevent the formation 



150 THE CARE OF THE BABY. 

of SO heavy a curd. Another useful preparation in some 
cases is one into which whey and cream enter (Appendix, 
14). Still another is the mixture of i part of cream and 
5 or 6 parts of water or barley-water. These cream mix- 
tures are often of great service where a child cannot take 
milk at all. The formula known as " Biedert's cream 
mixture," proposed by the celebrated German physician 
of that name, and intended for babies under three months 
of age, is one of this sort. There are still other prepara- 
tions, such as albumen-water (Appendix, 3), veal tea 
(Appendix, 16), etc., which contain neither milk nor 
cream. Their use, however, is limited entirely to children 
who are actually ill rather than to those with delicate di- 
gestion merely or with some idiosyncrasy regarding food. 

In some instances peptonizing the food is of great 
service. The method of doing this will be described 
later (Appendix, 23-35). ^^ must bear in mind that the 
administration of a predigested food during a long period 
takes away, to some extent, the power of the stomach to 
do its own digestion. 

The admixture of thickening substances containing 
starch for the purpose of "breaking the curd " is not to 
be recommended as a routine practice. In some in- 
stances, however, it is certainly of benefit. (See Oat- 
meal-water, Arrowroot-water, and Flour-ball; Appendix, 
5. 6, 17). 

In this connection we may consider more at length tlie 
very important subject already referred to — that of the 
administration of food containing starch. An infant in 
the first four months of life possesses only slight power 
of digesting starch. The pancreatic juice and the saliva, 
the function of which it is to digest starch, are little devel- 
oped at this period, and even after the age of four months 
the power increases but slowly. It is a very frequent cus- 



FEEDING THE BABY. I5I 

torn with mothers to give children a crust of bread to bite 
upon. Indeed, a baby is lucky if it gets off without any 
further maternal experimentation than this, for it is 
during the first eighteen months of life that so many 
innocents are slaughtered by "just a taste " of table food, 
given on the ground that because they wanted it, it was 
right for them to have it. It is best not to allow even a 
crust before the child is eight or nine months old, by 
which time a thriving baby may take starch in small 
quantities without disadvantage in the winter, although 
it does not need it. The better course, however, is to 
allow no starch, nor, in fact, anything but milk, until 
the age of one year. In hot weather no change whatever 
should be made in the diet until autumn, even though 
the child be more than a year old. 

Of course, these remarks apply only to thriving chil- 
dren. It sometimes happens in the last months of the 
first year, or even earlier, that the diet must be supple- 
mented in various ways, as by certain meat foods, such 
as the yellow of ^%%^ beef-juice and various peptonized- 
beef preparations, and sometimes even by starch in con- 
siderable quantity; but a healthy baby does not need 
these things, and should not receive them except by 
medical advice. So, too, it is often necessary during the 
latter part of the first year, if the baby is not growing at 
the proper rate, to increase the amount of milk in the 
mixture to, perhaps, one-quarter, one-half, or even a 
larger fraction of the total volume; but this should not 
be done unless it is actually and undoubtedly required. 

We have so far considered only the manner of feeding 
a baby before the time of weaning. After it has been 
fully weaned its nourishment may be gradually increased 
in strength. This applies equally well to a bottle-fed baby 
who has reached the usual age for weaning. By about 



t^2 THE CARE OF THE BABY. 

the age of twelve months a child may be fed upon undi- 
luted milk and may begin to take other articles of diet 
in addition, such as beef-juice, eggs, and starchy food in 
moderate quantity. These will be given from a spoon, 
but the milk may be given from a bottle as long as the 
child is inclined to take it in this way. 

As a guide for the feeding of a child of from twelve to 
eighteen months the following diet list may be of service. 
The numbered menus indicate the choice that the mother 
may have, alternating them so that the child will not tire 
of any: 

Diet from One Year to Eighteen Months. 

Breakfast (6 to 7 a. m.). — (i) A glass of milk with stale bread 
broken in it. (2) Oatmeal, arrowroot, wheaten grits, hom- 
iny grits, etc., made into a porridge with milk and well 
cooked for two hours at least. (3) A soft-boiled or poached 
^%% with bread broken in it, and a glass of milk. 

Second Meal (10 a. m.). — A glass of milk. 

Dinner (1.30 to 2 p. m.) — (i) Bread moistened with dish-gra\'>^ 
(no fat), beef-tea, or beef-juice (Appendix, 22) ; a glass of 
milk. (2) Rice or grits moistened in the same wa^' ; a 
glass of milk. (3) A soft-boiled ^%% and stale bread 
thinly buttered ; a glass of milk. 
Rice, sago, or tapioca pudding, or junket, in small quantities 
as dessert with any of these diets. 

Fourth Meal (5 p. m.). — A glass of milk or some bread and 
milk. 

Fifth Meal (9 to 10 p. m.). — A glass of milk. 

It is, of course, understood that the baby does not sud- 
denly plunge into any such diet at twelve months, but 
that the list and the variety are only very gradually in- 
creased, and that milk remains the principal article of 
diet. The last meal should be given only if the child 
wakens. If it rouses some hours before the time for the 
first morning meal, and remains awake, it should be 



FEEDIXG THE BABY. T53 

given a cup of milk to stay the stomach until breakfast. 
It is no longer necessary at this age to sterilize the milk 
in cool weather, if care is taken to keep it carefully. 
In hot weather it is safer to sterilize it still. 

After the age of eighteen months up to that of two 
years the diet is only very little more extended. The 
following list will be a guide: 

Diet from Eighteen Months to Two Years. 

Breakfast (7 A. m.). — (1) A glass ofniilk with a slice of bread and 
butter or a soda, Graham, oatmeal, or similar unsweetened 
biscuit. (2) A soft-boiled ^%% with bread and butter and a 
glass of milk. (3) Porridge as described in the previous list. 

Second Meal (10 A. m.). — (i) Bread broken in milk. (2) Bread 
and butter or a soda or other biscuit with a glass of milk. 

Dinner (2 p.m.). — (r) Boiled rice or a baked potato mashed and 
moistened with dish-gravy or beef-juice; a glass of milk. 
(2) Mutton or chicken broth with barley or rice in it, or 
"beef food;" some bread and butter, and some sago or 
rice pudding made with milk. (3) A small portion of 
minced white meat of chicken, turkej', or fish, or minced 
rare roast-beef, beefsteak, lamb, or mutton ; bread and 
butter ; a glass of milk. 

Fourth Meal (5 p.m.).— (i) Bread and milk. (2) Bread and 
butter and a glass of milk. 

It is probable that no fifth meal will be needed, but if 
it is it should consist only of milk. The term ''beef 
food " is used here in the very general sense of some of 
the commercial ready-made beef preparations. Among 
the best are those in which the beef is already peptonized. 
There are a number of excellent foods on the market, 
but the family physician had better be consulted regard- 
ing them. It is important to know that not every child 
can digest potato easily, and that this variety of starchy 
food must be tried with caution. Further, that many 
children have great difficulty in digesting any form of 



154 THE CARE OF THE BABY. 

starch. In such cases the diet should be chiefly of ani- 
mal food during the first two years of life. 

After the child has cut sixteen or twenty teeth — say, 
by the age of two years — we may still further increase 
the diet by allowing it to eat solid meat food. For dinner 
it may have tender chicken, fish, mutton, or beef cut 
small but without actual mincing. Fresh or stewed 
fruits in small quantity are also good, among these being 
included raspberries, strawberries, grapes freed from the 
seeds, peaches, juice of oranges, and stewed apples. 
Bananas should not be given. The diet then may be as 
follows : 

Diet from Two to Three Years. 

Breakfast (7 to 8 a. m.). — (i) A small portion of beef-steak, 
with oatmeal, hominy grits, wheaten grits, corn meal, or 
other cereal porridge with plenty of milk. (2) A soft- 
boiled Q%%, bread and butter, and a glass of milk. 

Second Meal (11 a. m.). — (i) A glass of milk with bread and 
butter or with a soda or other biscuit. (2) Bread and 
milk. (3) Chicken or mutton broth. 

Dinner (2 p.m.). — Roasted fowl, mutton, or beef cut fine; 
mashed baked potato with butter or dish-grav\' on it ; 
bread and butter. As dessert, tapioca, sago, or rice pud- 
ding, junket, or some of the fruits mentioned. 

Supper (6 p. m.). — (i) Bread and butter. (2) Milk with soda or 
similar biscuit or with bread and butter. 

It is very necessar}^ to bear in mind two facts regard- 
ing these tables: first, that they are only a guide, not 
an absolute rule, both as to the time of meals and as to 
the nature of the food; and, second, that they rather 
represent the extreme of what a child can take than in- 
dicate what every child ought to have. Although 
motliers are very prone to worry because their children 
are not getting "strong enough food," there is less 
danger of this happening than of the food being too 



I 



FEEDING THE BABY. 155 

strong. Many a baby does wonderfully well with milk 
alone long after others are taking a diet somewhat like 
the list given for the age of eighteen months to two 
years. In such a case it is folly to alter the diet hastily. 
The weight and the general condition of the baby are far 
better guides than the number of months old which it hap- 
pens to be or the number of teeth cut. It is always very 
important, as previously pointed out, to make no changes 
during the hot weather when it is possible to avoid doing 
so. On the least disturbance of the digestion, too, the 
diet should be cut down to milk for a day or two. 

From the age of about two and a half years onward the 
child can sit at the table in its high chair with the 
family, or at a small table close to the mother. If it 
never receives articles of diet not suited to it, it will 
soon learn not to ask for them. At the age of three 
years the child may have its diet considerably increased 
in variety, since it has now acquired powers of digestion 
much more like those of the adult. Some of the green 
vegetables are of advantage. It is very important at this 
age to prevent a child from helping itself to all sorts of 
edible articles both at the table and, especially, between 
meals. If it is really hungry there is no objection to its 
having some simple thing between meals, not sufficient 
in amount to lessen the appetite at the regular meal-time. 
It is impossible to give any series of distinct diet lists for 
the age of three years and onward, inasmuch as the child 
now eats from the family table and of the food provided 
for all. Care must be taken that it receives no indigesti- 
ble, highly-seasoned, or made-over dishes, and that it 
masticates slowly and thoroughly. The chief meal 
(dinner) ought always to be in the middle of the day, and 
the supper always light, as of bread and milk or cereals 
and milk, in order that sleep may be sound. Milk should 



156 THE CARE OF THE BABY. 

still constitute a large part of the diet, and meat more 
than once a day is often a disadvantage. The following 
lists may serve as a guide to the kinds of food suitable to 
a child of three years and later, and those which must 
be used with care or be avoided. Of course, as the child 
passes this age the list of permissible articles gradually 
increases until, by the time of puberty or earlier, the diet 
is practically that of adults. 

Foods Permitted. 

Meats. — Broiled beef-steak, lamb chops, and chicken ; stewed 
liver ; roasted or boiled beef, mutton, lamb, chicken, and 
turkey ; broiled or boiled fish ; raw or stewed 03-sters. 

Eggs. — Soft-boiled, poached, scrambled, omelette. 

Cereals. — Light and not too fresh wheaten and Graham bread, 
toast, zwieback ; plain unsweetened biscuit, as oatmeal, 
Graham, soda, water, etc. ; hominj- grits, wheaten grits, 
corn meal, barley-, rice, oatmeal, maccaroni, etc. 

Soups. — Plain soup and broth of nearly any kind. 

Vegetables. — White potatoes, boiled onions, spinach, peas, 
asparagus, except the hard parts, string and other beans, 
salsify, lettuce, stewed celery, 3'oung beets, arrowroot, 
tapioca, sago, etc. 

Fruits. — Nearly all if stewed and sweetened ; of raw fruits, 
peaches are one of the best ; pears, well-ripened and fresh 
raspberries, vStra wherries, blackberries, grapes without the 
skin and seeds. 

Desserts. — Light puddings, as rice pudding without raisins, 
bread pudding, etc., plain custards, wine jelh-, ice-cream. 

Food to be Taken with Considerable Caution. 

Kidne}-, muffins, hot rolls, sweet potatoes, baked beans, squash, 
turnips, parsnips, carrots, egg-plant, stewed tomatoes, green corn, 
cherries, plums, apples, huckleberries, gooseberries, currants. 

Foods to be Avoided. 

Fried food of an \' kind; griddle-cakes; pork; highly-seasoned 
food; pastry; all heavy, dough}', or ver}- sweet puddings, unripe. 



SLEEP. 157 

sour, or wilted fruit; bananas, pineapples, cucumbers, raw celery, 
raw tomatoes, cabbage, cauliflower, nuts, candies, preserved fruits, 
tea, coffee, alcoholic beverages. 

The feeding of a child when sick is such an important 
matter, and one so very difficult, that it must be left nearly 
entirely to the judgment of the physician. The remarks 
already made upon the feeding of children with delicate 
stomachs or with idiosyncrasies regarding food apply in 
this connection also. The further brief consideration 
which we can give to the general principles underlying 
the stibject will be found in Chapter XI., in the section 
upon the Management of Sick Children. 

In the Appendix will be found some recipes for various 
forms of food useful in sickness and health, including 
food-preparations for use in the bottle. 



CHAPTER VII 
SLEEP. 

Avery young baby is asleep nearly all the time except 
when nursing or having its toilet made. Its total amount 
of sleep should be about eighteen or nineteen hours every 
day. As it grows older it sleeps less and less, and at the 
age of two months it will often lie awake quietly for an 
hour or so at a time. By the time it is a year old it 
requires fifteen or sixteen hours of sleep everyday; at 
two to three years, twelve or thirteen hours; at four to 
five years, ten or eleven hours; and at twelve to thirteen 
years, nine or ten hours. A baby who is sleepless and 
fretful at night generally has something the matter 
with it or else has been badly trained. It is important 
from the very first to accustom a child to sleep at definite 
hours, else the parents' lives are in danger of becoming 
a burden to them. To walk the floor night after night 



158 THE CARE OF THE BABY. 

or to be obliged to sit up with a healthy child and sing 
it to sleep is a form of martyrdom which is entirely un- 
called for. Provided one is sure that the baby is not sick, 
it should be put to bed and not be taken up again to 
induce it to sleep, and the mother should avoid sitting in 
the room unless she wishes to be obliged to sit there every 
evening. If the little one never knows any other way 
than this of being put to sleep, there will usually be no 
difficulty in the matter after it has once learned its les- 
son; but to begin the training and not persistently to 
continue it is a fatal yielding of which the child will be 
sure to take advantage when a second battle begins. 

Except for the first few days of life, during which, as 
is generally thought best, it should lie on its right side 
as much as possible, the position which a healthy child 
assumes while sleeping is a matter of not the slightest 
consequence. If it wants to lie on its stomach, there is 
no possible good objection to be raised against it. There 
is sometimes a great deal of needless anxiety among 
mothers with regard to this matter. It is only in a rickety 
child that a deformity w^ould be liable to occur from the 
habit — as would equally well result from the constant as- 
sumption of any other position. We must remember the 
necessity of changing the position now and then of ever>^ 
child too young or too feeble to turn itself easily and often. 

Before the age of three or four months the baby is put 
to bed at 5.30 or 6 p. m., and should rouse but once or 
twice during the night. After this age it should go to 
bed at 6 or 7 in the evening after nursing, be fed at 10 
or II p. M., but be trained to sleep without further nurs- 
ing until 6 or 7 in the morning. It will then need feed- 
ing again, after which it can again sleep if it desires. 
Through the day it may at first sleep as much as it feels 
inclined, but it is sometimes a good plan, by the time it 



SLEEP. 1 59 

is a month old, to encourage its keeping awake for about 
an hour before its bed-time, in order that it may have a 
better night's rest. 

By the time the baby is six months old it will probably 
begin to limit its sleep by day to a nap in the morning 
of from one and a half to two hours. The time of the 
morning nap will depend largely upon the hours of nurs- 
ing. The child should be undressed for it and be regu- 
larly put to bed. Sometimes at this age a short after- 
noon nap is needed, but this should not last longer than 
until 4 P. M., lest the night's rest be interfered with, and 
it should not be allowed unless the child cannot do with- 
out it. At one year of age and on to the age of two 
years the same arrangement of the sleeping hours holds 
good, except that an afternoon nap is not desirable. The 
morning sleep will then be of two hours' duration, begin- 
ning at II or 12. If the fifth meal at lo p. M. is not 
required, the child can sleep uninterruptedly throughout 
the whole night. At two years of age the morning sleep 
is shortened to one-half or one hour. From this time up 
to the age of four or five the morning sleep is still taken 
if the child seems to need it, but is not to be insisted 
upon. Children of four years or older should continue to 
go to bed at 8 o'clock or earlier, and the hour should 
gradually be changed to 9 o'clock by the age of ten or 
twelve years. 

A certain degree of latitude is to be allowed to all that 
has been said. For instance, if a child persistently 
wakens very early in the morning and does not go to 
sleep again, it is better to make the bedtime somewhat 
later. So, too, a child must be allowed to wake of its 
own accord in the morning, even though the regular 
hour be passed. This is certainly true up to the age of 
four or five years, and even after this it must be remem- 



l60 THE CARE OF THE BABY. 

bered that children need a great deal of sleep. If rising 
at a certain hour in the morning is necessary, and the 
child seems tired, the hour for retiring must be made a 
little earlier. In no case must the amount of sleep 
desired be curtailed. A child of any age should not be 
allowed to lie in bed after thoroughly awake. 

It is important to preserve great regularity in the hours 
of sleeping. Few things upset a child more than a failure to 
do this. There should be no romping games or excite- 
ment of any nature for at least an hour before going to 
bed at night, or the child will be apt to sleep badly. 

We must next determine what is best for the baby to 
sleep in. It should never sleep in the bed with its 
mother. Not only is there a possible danger of her over- 
laying it — a danger which is real and not imaginary, 
since statistics show that it occurs very frequently, and 
history records it even as long ago as the time of King 
Solomon — but there is a constant temptation to nurse it 
too often. The baby, on its part, acquires the bad habit 
of nursing only partially, sleeping a short time, rousing, 
and nursing again. Moreover, it is very liable to get the 
covers over its head and to obtain much less fresh air 
than it should. 

The first bed generally used for the baby is the bas- 
sinet, and sleep should begin in this from the first day of 
life. The bassinet consists of a wicker basket with high 
sides and with or without a hood over one end. It 
should stand high, so as to avoid draughts on the floor. 
It should not be too large to be easily portable, in order 
that it may be readily moved from one room to another 
if desired. It may conveniently be lined with some 
colored or white material and covered outside with Swiss 
muslin; but these and any further decorations may 
be as varied and as elaborate as the mother pleases. It 



SLEEP. 



i6t 



is, however, better to have them simple and inexpen- 
sive, to permit of changing them when dusty or soiled. 
The illustration shows one of the ordinary forms of bas- 
sinet furnished in the shops (Fig. 37). A large oval 
clothes-basket would answer as a substitute. 




Fig. 37. — Bassinet. 

The bassinet is superior to the crib for the early 
months of life, because it gives the child more support at 
the sides and keeps it warmer if well tucked in. Cur- 
tains may be fitted to it, and are of service if there is 
any danger of draughts, but as they cut off the fresh air 
and catch the dust it is better to do without them; 
place the bassinet in a sheltered situation, and protect 
11 



1 62 THE CARE OF THE BABY. 

it, if necessary, from draughts and light by a portable 
screen. 

A cradle may be used instead of the bassinet. The 
form with projecting rockers is a constant invitation to 
everybody to trip over them, and the swinging form is 
also not to be recommended unless it is never swung. 
Although the rocking probably does no harm, it is 
against all the principles of training which we have been 
considering to make it a necessity in putting the child to 
sleep. If the child has never been rocked, it can never 
miss it. 

When the baby is eight or nine months old it should 
be transferred to a crib, in which it should sleep until five 
years of age. The crib should have sides which let down 
on hinges or on slides, and which should be high enough 
to prevent falling out, for it is astonishing over what 
high sides a small child can climb. The hinged side 
takes up much more room in opening, and the sliding 
variety is consequently more convenient if it is so made 
that the child cannot by any means let it down upon its 
arms or legs. The old-fashioned trundle-bed is faulty, 
as it brings the child too near the draughts on the 
floor. The crib is, as a rule, better without curtains. It 
should be provided with a woven-wire mattress, and this 
should be as high from the floor as in an ordinary bed. 
The remaining contents and the manner of making up 
the bed are the same as for the bassinet, and the one de- 
scription answers for both. There should be, namely, a 
soft, thin hair mattress, which is decidedly better for strong 
children than one of feathers is, as the latter is much too 
warm. Over this is laid a rubber cloth, and the whole 
is covered by a doubled sheet. Sometimes a quilted bed- 
cover may be put over the rubber, to increase the softness 
and warmth. This is a very good plan in winter. It is 



SLEEP. 163 

also sometimes well to place a small pad, like the lap- 
protector described in Chapter V., directly under the 
baby, over the sheet. There should be a small, soft, 
thin feather pillow covered with a fine linen pillow-slip. 
In summer a pillow of curled hair is cooler. The cov- 
erings of the baby in bed consist of a sheet, as many soft 
blankets as the season requires, and a light spread. In 
cold weather an eiderdown quilt is very useful. All the 
coverings should be light in weight, yet warm. The 
sheet should be of muslin rather than of linen, as there 
is a coldness about the latter which it is very difficult to 
overcome. The pillow-cases, however, are better made 
of linen. 

We must constantly bear in mind the very great im- 
portance of properly airing the bed after it has been slept 
in, and of warming it before it is used again. Every 
morning the windows of the room should be opened and 
the bed-covers be stripped off, and, with the mattress, 
exposed to the air and sun for at least two hours. Before 
the child is put to bed in the evening the covers should 
be well pulled down and allowed to stay so for half an 
hour or more. In cold weather the sheets should be 
taken off and warmed. Indeed, it is a good plan to warm 
them at all seasons except in the height of summer. If 
this is done, there is no necessity for a child to sleep 
between blankets, unless, possibly, in earliest infancy. 
It is difficult to keep blankets fresh and sweet if used in 
this way. If the sheets become soiled, they must be 
changed at once, no matter how often the soiling occurs. 
It is important to keep the rubber cloth well cleaned and 
aired. 

The great disposition evinced by most children to 
wriggle themselves outside of the bed-clothes renders 
something to prevent this desirable. There are many • 



164 THE CARE OF THE BABY. 

bed-clothes fasteners described, but as simple a form as 
any consists of two short pieces of elastic, each of which 
is attached to the covers by a clamp and is fastened to 
the side of the bed or crib by pieces of ribbon. This plan 
is rather better than that of pinning the covers to the 
pillows with large safety pins, since the elastic allows of 
a certain degree of turning and moving about. 

Where the child shall sleep at night is a matter de- 
pending largely upon circumstances. The best plan, 
theoretically, is that which places the baby, after the first 
few weeks, with its nurse in the night nursery. If the 
child is nourished at the breast, it can be brought to the 
mother's room at the proper hours and then be taken 
back. This relieves the mother of care during the night. 
If it is bottle-fed, the nurse gives it its nourishment. 
Many a mother, however, is naturally, and with good 
reason, unwilling to entrust so much responsibility to any 
employed person, while in other cases the means of the 
parents or the rooms of the house do not permit of such 
an arrangement, and the baby has to sleep in the 
mother's room. After the age of a year, however, it 
should certainly have a separate room at night if pos- 
sible. The morning and afternoon naps are to be taken 
in the room used for sleeping in at night. 



CHAPTER VIII. 

EXERCISE AND TRAINING, PHYSICAL. MENTAL, AND 

MORAL. 

The training of the baby, physically, mentally, and 
morally, is so large a subject that we can consider only 
its most salient points. 



!3 



INFANT'S WBiaHT CHART. 




EXERCISE AND TRAINING. 1 65 

For the first two weeks of life the baby takes very little 
physical exercise, but after this it begins to kick and to 
move its arms about in a way which ensures plenty of it, 
if only its clothes are of such a nature that the move- 
ments are not impeded. At the age of two weeks the 
child may be systematically carried about in the arms 
two or three times a day, as a means of furnishing 
additional change of position. We must bear in mind that 
its spine is still very weak, and that it must be supported 
in a proper manner. The baby should be placed on its 
back upon a pillow on the nurse's arm, and after it is a 
month old it may be carried in the same way, but with- 
out the pillow. When three or four months old, and up 
to the age of six or eight months, it may be seated up- 
right upon the arm, with the hand of the other side sup- 
porting its head and back carefully, although as the age 
advances this support is not always necessary. As the 
back bends very easily in any direction in infancy, we 
must guard against any permanent cur^'ature developing 
by seeing that the child is carried sometimes on one arm 
and sometimes on the other. 

Closely connected with the exercising of the baby is 
its exposure to the outdoor air. Although this is often 
of much benefit, it is a mistake to be in too great a hurry 
with the process of "hardening," so called, since this 
frequently only succeeds in making the child ill, just as 
pampering makes it delicate. No absolute rule can be 
given for the date at which the baby shall be taken out 
for the first time. If at the age of two weeks it is well 
and is properly protected, the nurse when walking with 
it may carry it into another room of a somewhat cooler 
temperature. This will give quite suflScient change of 
air. By the time it is a month old, or even before this, 
it may be taken into the open air in summer-time, and 



1 66 THE CARE OF THE BABY. 

kept there for ten or twenty minutes on the first visit, 
and longer on subsequent ones. In midwinter it is better 
to delay longer, and not to make the first excursion out 
of doors until the age of two or possibly three months. 
There is no doubt that it is sometimes still wiser to wait 
until spring if the baby has been born in the winter 
season, but this must be determined largely by circum- 
stances and for each individual case. An autumn baby 
ought, if possible, to go out before winter sets in, and 
then to continue to do this on all good da3's. 

Damp, windy, or very cold days are always to be 
avoided during the early months of life, and even after 
this period exposure to them is of questionable advantage, 
for we have always to balance the good that may come 
from the outing against the harm that may result from 
the unfavorable weather. It is a mistaken idea that 
every child must be in the open air every day, no matter 
what the nature of the weather may be. Even on the 
best days it is important to avoid chilling and to keep a 
close watch over the condition of the hands and feet. 
The least chilliness of these is a warning to go in. 

One plan which can be safely adopted with autumn or 
winter babies is that of opening the windows in one of 
the rooms of the house, wrapping the baby thoroughly, 
and walking wnth it in this room for half an hour or so, 
just as though it were out of doors. The windows should 
at first be shut down before the baby is taken into the 
room, but later they may be left open if the weather is 
not too cold. Of course, draughts must be avoided. 

The first going out should be in the nurse's arms, since 
the heat of her body keeps the child warm, and the sup- 
port of her arm and hand renders it much more comfort- 
able. After the age of three or four months, depending 
on the season, it may be taken out in a perambulator. 



EXERCISE AND TRAINING. 1 6/ 

The choice of the perambulator and the manner in 
which it shall be used are matters of much importance. 
The perambulator should be well balanced, so that 
there is no danger of it "tipping over backward, and 
should especially have easy springs, in order to save the 
baby as far as possible from the results of careless wheel- 
ing. It should be provided with an adjustable seat for 
use when the child begins to sit up. It should also have 
a detachable overhanging sun-shade or adjustable hood 
for use in the sun. It is necessary, too, to see that this is 
always taken with the carriage and is always used when 
needed, for nothing is more common than to find a care- 
less nurse wheeling a baby with the sun full in its face. 
The color of the shade, or rather of its lining, is a very 
important matter too often overlooked. One which is 
white or of some bright color, such as red or yellow, m.ay 
seriously injure the eyes, for it reflects into them the 
glare from the ground. At least the lining ought to be 
of some dark color, such as green or brown. The car- 
riage should be provided with a soft warm bed and with 
warm covers and a pillow. A knitted or crocheted afghan 
is a serviceable article. For use in summer, mattresses 
and pillows of hair are much cooler than those of feathers. 

As the baby grows more active there is very great dan- 
ger of its falling out of its carriage. To prevent this 
accident most perambulators are provided with a straight 
strap in front of the child. This is often very unsatisfac- 
tory, since it does not keep the child either from climbing 
over, if active, or from being thrown out in case of acci- 
dent. Some really serviceable preventive of this very 
real danger of falling is required, and a very good form 
is that shown in the illustration. This consists of a strap 
which goes entirely around the waist and is attached by 
smaller straps to the sides of the carriage (Fig. 38). 




1 6^ THE CARE OF THE BABY. 

A child that has reached the age of six months will 
no longer be content to lie flat in its carriage. It is then 

necessary to see that it is well 
supported with extra pillows 
at the back and sides. For 
children of this age, or for 
older ones who can sit easily 
without support, the adjusta- 
ble seat should be placed in 
_ „ ^ , , the coach. 

Fig. 38.— Strap for coach. ^ , _ - 

From the age of three 
months onward it is an excellent plan to place the 
baby at times upon a blanket or mattress in some 
place in the room which is free from draughts, and 
so to- arrange its clothing that it is allowed to make 
freely all the motions of which it is capable. This 
gives it a good chance to learn to stand or to creep as 
soon as it reaches the age for it. A clothes-basket or 
large box padded with soft material makes a good place 
for this early exercise. Whether or not the child shall 
creep upon the floor depends on circumstances. In win- 
ter the lowest layer of air is very apt to be cool, and in 
severe weather the use of the floor is almost out of the 
question, even though the nursery has comparatively few 
draughts. So, too, if a child has a cold, it had better be 
kept off* the floor until well again. The creeping apron 
described elsewhere is very serviceable for keeping the 
air from the child. To prevent a creeping child from 
reaching unsuitable parts of the room it is a good plan to 
place it within a small portable pen. The portions of the 
fence are separable, so that the whole can be put away 
in small compass when not in use. Pens of this kind 
can be bought or can easily be made (Fig. 39). 

Efforts at walking give the baby abundance of a new 



EXERCISE AND TRAINING. 



169 



kind of exercise, and we must take particular heed that 
it is not overdone. Too much cannot be said in favor of 




Fig. 39. — Creeping pen. 

letting the baby take its own time in making the new 
acquisition. No appliances to aid walking should be used, 
and the child should not be urged at all. The advisabil- 
ity of using baby-jumpers is very questionable. If there 
seems to be a tendency for the legs or ankles to bend, 
walking must be discouraged entirely, for it is much 
easier to prevent the deformity than to correct it. At this 
period of life the child should still be kept in the peram- 
bulator during the daily airing, but later, when it has 
learned to walk pretty well, it may have ten or fifteen 
minutes' additional outdoor exercise on its feet. Gradu- 
ally the duration of the outdoor walk may be increased, 
but the perambulator must still be used for most of the 
time until the child is two and a half or three years old. 
A half mile at the most is quite sufficient, and often more 
than enough, for a walk at this age. 

Sometimes children who have outgrown the perambu- 
lator will ride with pleasure in a "play" express- wagon 
or, in winter, on a sled. The little two-wheeled carts 
for children, made in various designs, and known by 
various names, such as "jaunting car," "mail cart," 



170 THE CARE OF THE BABY. 

''chair car," and the like (Fig. 40), have become very 
popular in the last few years, and are most serviceable. 
Certainly some vehicle ought to be ready at hand at this 




Fig. 40. — Mail-cart. 

period of life. We are too prone to forget how short the 
legs of little children are, and how easily their strength 
is exhausted. 

There is one form of compulsory exercise which should 
be carefully avoided. I refer to the trotting on the 
knee which is so common with many nurses. When one 
compares the diminutive size of the baby, lying on its 
back or stomach in the nurse's lap, with the vigor of the 
trotting to which it is subjected, there can be no surprise 
awakened if vomiting and other disturbances of digestion 
are produced. Even should these not occur, the habit is 
a bad one, since the baby may gradually become accus- 
tomed even to this hard usage, and learn to depend on it 
for being put to sleep, just as it will depend on singing 
or rocking when used for this purpose. 

In this connection we may leave for a moment the 
exercise of the body-muscles in general to consider the 
training of certain others — namely, those which control 
the emptying of the bladder and the bowels. After it is 



EXERCISE AND TRAINING. I7I 

three months old the baby becomes conscious of these 
acts, and often at this early age, or sometimes before it, 
its education may be begun. It is most liable to empty 
its bladder soon after a meal, and to open its bowels with 
some regularity as to time. If the mother will place a 
receptacle under it while it is lying in her lap a little 
while before either evacuation is expected, the child will 
very gradually learn to recognize the purpose of the pro- 
cedure. Perhaps the event may be aided by the mother 
or nurse systematically making some sound at the time, 
which the child will learn to associate with it. As the 
baby grows old enough to sit up, even though partially 
supported, it may be placed in the nursery chair at the 
proper time, and always with the greatest regularity as to 
the hour. Patience and perseverance will accomplish the 
desired teaching at last. It scarcely need be remarked 
that punishment for delinquencies in this line is totally 
out of the question at any age. Of course, children dif- 
fer in the rapidity with which they learn this control. 
Many have accomplished it by the age of a year; most 
should have done so by eighteen months of age; all 
ought to have learned it by the end of the second year at 
latest, and some may be trusted during the day when six 
months old, or even considerably less than this. The 
control is always decidedly less during the night. 

With increasing age children become able to take with- 
out fatigue an amount of exisrcise which is really aston- 
ishing. Still, there is the necessity of guarding constantly 
against an excess of it in the excitement of play, as well 
as of seeing that every portion of the body shares in it. 
Rolling hoop can be begun'by quite young children, and 
the use of a rocking-horse is valuable for exercise in the 
nursery. A velocipede which cannot be upset will be of 
service as soon as a child is old enough to use it. For 



1/2 THE CARE OF THE BABY. 

older children dancing is a very desirable indoor exercise 
if done in moderation and with proper precautions 
against taking cold. The objections so often urged against 
skipping rope are in no way valid unless the exercise is 
indulged in to great excess. After the age of puberty, 
however, it may be harmful to delicate girls. Skating, 
especially on ice, is excellent, under proper precautions, 
for both boys and girls. There is, of course, the risk 
of falls, but no active sports are unattended by some ele- 
ment of danger. The art of swimming should be acquired 
by every child, not only for the exercise which it gives, 
but also for the safety which it may some time ensure. 
The use of the bicycle is to be commended, provided the 
guiding apparatus be of such a height and so placed 
that the child cannot stoop over in the position so gener- 
ally assumed by bicyclists, and provided that this form of 
exercise be not employed too exclusively; for although 
the lower extremities are well used, the upper ones are 
not sufficiently so, and the position of the anns tends to 
contract the chest. Tennis and other outdoor games may 
be indulged in freely. Nothing can be better for chil- 
dren than riding, first on a donkey or pony, and later on 
a horse — the girls, of course, riding astride, just as the 
boys do. Indeed, none of these outdoor sports are 
intended for boys alone, and girls should be encouraged 
to take part in all of them. Many a woman has to thank 
her romping, outdoor girl-life for the robust health which 
she afterwards enjoys. Let the girl be a hoyden just as 
long as she pleases — the longer the better. Sedentar}^ 
indoor amusements should, in fact, be discouraged. It 
is much easier to tone her down and " make a lady " of 
her after a while than it is to tone her up if she has no 
good constitution on which to build. A girl grows into 
a " tiling of beauty " only if of sound health. 



EXERCISE AND TRAINING. 1 73 

A city-bred child, however, has little opportunity of 
taking the necessary amount of exercise of any kind, 
unless a park or an open square be somewhere in the 
vicinity. It is consequently of the greatest benefit to 
take growing children to the country, mountains, or sea- 
side for as much as possible of the warmer season of the 
year. Places which are merely fashionable resorts are 
not suitable unless the children are in no way trammelled 
by the restrictions from which their elders suffer. 

Even though plenty of exercise can be had in summer, 
the inclemency of the weather in winter often presents a 
great obstacle to obtaining it at that season. Besides 
this, the confinement of school-life in winter often tells 
upon the health of the child. It is now that the well- 
regulated gymnasium fills a place taken by nothing else. 
It would be a wonderful aid to the formation of sound 
health did every child attend one systematically. It is 
much better to spend a half hour or fifteen minutes there 
every day than it is to exercise for a longer period only 
two or three times a week. Where no gymnasium is 
available much can be done at home. One of the best 
methods for delevoping the arms and chest consists in 
swinging on a low swing or hanging for a few moments 
by the arms from a horizontal bar, repeating this fre- 
quently during the day. Swedish movements are of 
great value, and massage is also of service, although less 
efficient. The calisthenic exercises now used at many 
schools are to be recommended highly. It is especially 
useful in the case of young children to have such exer- 
cise accompanied by music, as it makes it of greater 
interest. 

The various sports w^hich have been referred to of 
course come under the head of Amusements also, and 
exercise the mind as well as the body. Childhood is 



174 THE CARE OF THE BABY, 

often called "the play- time of life." The chief occupa- 
tion of the child is to play, and everything else must be 
made subservient to this. The training of the mind can 
be combined with it, but should always hold a secondary 
place, for there is little use of a sound mind, and little 
chance of getting it, unless the body, too, be sound. 
Still, while the child is playing it is learning, and the 
acquiring of knowledge commences often before we have 
any idea of it. As we cannot hinder the learning, we 
must early begin to superintend it, and to guide the 
baby in its amusements, as well as in other things, in a 
line which will instruct both its mind and its moral sense. 

We can in the limits of this chapter merely touch on 
some of the matters connected with the mental and inoral 
training. Early in life the baby needs ver}' little diver- 
sion. Indeed, up to the age of five or six months it does 
not require playthings, although at this age it will be 
amused by a rattle or a rubber doll. Later it needs more 
toys to be used in the house on rainy days, and others 
which it can play with out of doors. A heap of clean 
sea sand will furnish a child of two or three years an un- 
ending source of amusement. 

It should not be forgotten that it is not only a foolish 
extravagance to load a child of any age with expensive 
and fragile toys, but that it is distinctly prejudicial also. 
Always looking for something new, the child soon 
becomes discontented with the things it has, no matter 
how fresh and good they may be. Lack of valuation, 
too, breeds lack of care of the playthings. Simplicity 
in desires will better be attained by having only a few 
toys, although certain others may be kept in reserve and 
be given only on special occasions or as a special favor 
or reward which has been well earned. Habits of neat- 
ness can be taught in the use of playthings, and even 



EXERCISE AND TRAINING. 1/5 

when small a child can learn the lesson of "a place for 
everything." Toys may be chosen which instruct. 
Picture-books, Noah's arks and animals, the kinder- 
garten toys, and, a little later, lettered blocks, are of this 
class. With the latter many a child has learned its letters 
almost without efifort or special instruction. 

There is really no hurry about teaching a child to 
talk. Of course, the more attention there is given to the 
matter, the sooner will most babies learn. The only 
thing which should be carefully borne in mind is the 
great folly of ever using ''baby-talk." It is no more 
comprehensible to the child and no easier for the mother. 
Gibberish talked to the baby means that it will learn 
only gibberish. Then at an age when it becomes a mor- 
tification to the parents the child of three or four years 
may still be talking a nearly unintelligible jargon. 

The constant questioning on the part of children is 
often very trying, but should never be rudely repressed. 
Bear with it patiently, even encourage it; answer truth- 
fully all you can, and remember how very much there is 
which the child is so anxious to learn all about. Of 
course there are times when the questions are out of place 
and must be gently checked. So, too, with the noise of 
children: although it is often disagreeable and needs to be 
stopped, we must never forget that to make a noise is nat- 
ural, and not to make it is a thing which has to be learned. 

It is important to remember that in the instruction 
of children example is far more valuable than precept. 
Children are wonderful imitators, and their words and 
actions will be copied largely from those with whom 
they are most intimately thrown. If a child is never 
told a falsehood by its parents or its nurse, and is taught 
to look upon it with horror, there will be little danger of 
its becoming untruthful. The punishing of a child for a 



176 THE CARE OF THE BABY. 

fault after it has told the truth about it is simply encour- 
aging it to lie on the next occasion. We must not, in this 
connection, overlook the fact that the excessively vivid im- 
agination of a child sometimes leads it to view its fancies 
as realities. Thus it will tell all manner of false stories 
of what it or others have done or said, and will often 
actually believe it all. This is only a sort of roman- 
cing, and must be sharply distinguished from deliberate 
lying, with which it has not the slightest connection. 

The habit of implicit, unquestioning obedience cannot 
be taught too early. It is of far too frequent occurrence 
for a mother to tell her child that if it will obey some 
command she will buy it a toy or reward it in some other 
way. There can be no greater folly than this, for the 
little one needs no great power of reasoning to under- 
stand that the act of obedience is thus made a favor done 
by it to its parent. To obey because the command is 
given and because the child loves its parents should be 
the only reason. This does not mean that a parent may 
be tyrannical, exacting, or unreasonable. Remember that 
the child ma}' be right and you wrong. 

One should never use threats or employ punishments 
unless they are really necessary. Punishment should be 
carefully selected, never given in anger, but in sorrow, 
and never of a nature that may frighten the child or 
injure its health in any way. The boxing of the ears 
may do serious harm, and imprisonment in dark closets 
and similar punishments are equally dangerous. When 
a child has been threatened with a punishment, and has, 
in spite of this, committed the forbidden act, it should not 
fail to pay the penalty, else it will soon learn to despise 
its parents' commands. Of course, exceptions arise where 
justice must be tempered with mercy, but these are to be 
exceptions only. If parents would less frequently tell 



EXERCISE AND TRAINING. 1/7 

their children '■'' don' t^''' but give them something to ^^, 
there would be fewer lapses from obedience. 

I have said so much in this connection about the import- 
ance of obedience because its value is especially great in 
sickness. Many a time a physician is rendered helpless 
to a great extent because a poorly-trained child refuses to 
take medicine prescribed for it, except after losing a 
pitched battle over it and doing its nervous system injury 
by the struggle. 

A freedom from selfishness is a quality which cannot 
be taught too early. A child should learn to think and 
to do for others, and not for itself This is a difficult 
lesson to learn, for we are all selfish by nature. It should 
also learn to have a fitting respect for and to act with 
gentleness and kindness to all created things, whether 
animate or inanimate. A child should never be told to 
"hit the bad floor" against which it has struck its head. 
This is nothing else than teaching revenge, to say noth- 
ing of the foolishness of it. 

As the child grows older one of the best means of incul- 
cating a love for and a sympathy with objects in nature is 
to allow it to have a growing plant or a pet of some kind 
of which it shall have the care. This teaches thoughtful- 
ness as well as serves as an amusement. Of course, we 
cannot expect the child to have the whole responsibility 
of the care of the pet, for this is asking too much of its 
perseverance and enthusiasm. The parents should assist, 
but must not take the whole care upon them. In this 
way the pet does not become a burden or a source of ill- 
advised reproaches. 

I must strongly advise against the common habit of 
making the baby the centre of an admiring circle of vis- 
itors. The baby should see just enough of company to 
teach it to be free from a dread of strangers. As a rule, 

12 



178 THE CARE OF THE BABY. 

however, it should not be brought into the parlor. The 
custom not only bores the visitors, too polite to say so, 
but it excites the baby far too much. A little later this 
course results in the development of a forward child who 
is always "showing oflf" or interrupting the conversa- 
tion of its elders. Children's parties, too, are far too 
exciting for babies, and even in early and later childhood 
they should be of rare occurrence and simple in their 
arrangements, and are best held in the very early evening 
or late afternoon. 

Much harm, sometimes irreparable, is often done by 
allowing a child to grow up almost entirely in the society 
of domestics. If parents want children to learn pleasing 
and polite manners, the use of good English, and refined 
modes of eating, they must associate their children with 
themselves; and if they themselves do not possess these 
qualities, they should cultivate them as thoroughly and 
rapidly as possible. In the effort to teach the child in 
these respects they may profitably let it appear at the 
general table as soon as it reaches the age of two and a 
half or three years, or at the most four years, unless 
company is present. It is a valuable safeguard against a 
child pushing its chair over if it is fastened in some way 
to the table. 

Very early we should begin to teach a child not to 
have unreasoning fear; and one of the best means of 
accomplishing this is never to let it be frightened. Such 
toys as the jack-in-the-box and those which make a sud- 
den loud noise should not be given to very young chil- 
dren, as they may be the cause of great fright. A 
child should be taught to have no fear of such things 
as mice, worms, and other innocent animals. It should 
look upon the dark as equally harmless with the light. 

Too great caution cannot be used in the choice of 



EXERCISE AND TRAINING. 1 79 

stories told or read to little children, since they sometimes 
gather from what seems to be least harmful the occasion 
of a timidity not easily recovered from. Ghost-stories 
are, of course, entirely out of the question. They have 
often been the cause of untold mental suffering and of a 
fear which a lifetime has not overcome. Even stories 
which excite the imagination too vividly are to be 
avoided, although they may be entirely free from ele- 
ments causing alarm. 

Up to the age of nine or ten years boys and girls are 
disposed to play together unless some too officious person 
has made the boys dislike the girls' games, and the girls 
feel that the boys are rough and ''horrid." No hinder- 
ance should be opposed to this joining in play, since it 
induces the girls to lead an active life. The mother 
should never forget, however, that it is important to ex- 
ercise careful although unobserved supervision over the 
morals of the children, whether the sexes play together 
or separately, since even those who appear perfectly in- 
nocent are by no means always so; nor is it invariably 
some one else's children who are at fault. Experience 
shows that almost no age is too young to need the sub- 
jection to this watchfulness. 

Finally, we must consider briefly the management of 
the school-life of children. With the comparatively 
recent improvements in schooling, children may be sent 
to a kindergarten by the age of three or four years. The 
key-note of the kindergarten is the acquiring of know- 
ledge by play. At the same time the child is amused and 
learns a certain degree of discipline and order. Many of 
the games are accompanied by little songs and move- 
ments of the body, which are always designed to impart 
knowlege of some sort. Thus the child sings of the 
flight of birds, and imitates the flying by the motion of 



l8o THE CARE OF THE BABY. 

the arms. It learns also of the harmony of colors by 
weaving colored papers, and gains manual dexterity at 
the same time. A knowledge of number and of form 
comes from playing with blocks. A grain of corn may 
be the text for a story about growth, and the child learns 
a song regarding this. 

These instances illustrate briefly the methods of the 
kindergarten. Whenever a good school of the kind is 
available, it should be utilized, and when it is not, the 
mother should herself devote some time daily to instruct- 
ing her child on the lines indicated. There are now 
many excellent manuals on kindergarten instruction 
which give details of the method of teaching. But with 
some children even the simple instruction of the kinder- 
garten may give too much mental work; for the learning 
of songs and rhymes is, of course, a decided mental 
effort. 

There is really no need to teach a child to read before 
the age of six years. Precocity is not a thing to be 
desired. Indeed, in delicate children it is to be dis- 
couraged strongly. It is not the slightest indication of 
talent or genius. Many children teach themselves their 
letters, as has already been mentioned; many go further, 
and learn to read with very little assistance if they have 
once been given the start; while still other children find 
study always a burden. If we have succeeded in getting 
the power of observation and attention well cultivated 
by the kindergarten object-lesson methods, reading will 
usually come readily enough. 

By the time the child is six or seven years old it may 
be given some regular lessons and do some actual study, 
but not at the expense of health, and the hours should 
be very short. Three or four hours daily are quite 
enough up to the age of ten years. Throughout the 



EXERCISE AND TRAINING. l8l 

early school-life there should be no studies to prepare at 
home, for the confinement of the school-hours is all that, 
and often more than, the health can stand. The great 
fault of the age as regards the mental training of children 
is that of over-pressure. We expect the children, with 
their brains still in a formative state, to do far more 
mental work than most of their elders do. The dano^er 
of over-study is particularly true in the case of girls, who 
are more disposed than boys toward a quiet, sedentary 
life; but both sexes must be most carefully guarded 
against too much brain-work. Eyes are often irreparably 
injured by school studies, not only as the result of in- 
sufficient or badly-placed light, but in consequence 
simply of too constant use. IMany cases of nearsighted- 
ness are the result of the improper use of the eyes early 
in life, or of e\'es which need correcting by glasses. 
Spinal curvature often results from faulty methods of 
sitting at school (see p. 218). 

It is very important in the "one-session " school that 
there be a recess of sufficient length to allow the child to 
obtain something more to eat than doughnuts and sweets. 
Indeed, attendance upon the best school in the world is 
not worth a hastily-swallowed breakfast and a hurried, 
indigestible lunch. In this respect, as in all others, 
schooling must always be secondary to the care of the 
health. The value of the use of gymnastic exercises has 
already been referred to earlier in this chapter. Where 
it is possible to do so a school should be selected which 
provides these for the children, since they not only prac- 
tise the muscles, but also make an excellent break in the 
tedium of the school-day and return the children re- 
freshed to their studies. 

The subject of the sending of older children to board- 
ing-school is too many-sided for consideration here. Over 



1 82 THE CARE OF THE BABY. 

against the advantage of the increased independence and 
self-reliance attained must be set the lack of parental and 
home influences and the danger of acquiring bad habits 
of all sorts. From a strictly medical standpoint we have 
chiefly to assure ourselves, in selecting a boarding-school, 
that the children do not pass either sleeping or waking 
hours in crowded and ill-ventilated rooms, that they are 
well fed, and that they receive abundant opportunity for 
exercise and sleep. 

The danger of contracting contagious diseases in either 
day-schools or boarding-schools must never be forgotten. 
Unfortunately, it is one from which there is no absolute 
safeguard, especially since many parents are utterly reck- 
less of the risk to other children which arises from send- 
ing back too soon their own children who have been 
ill. The periods of quarantine for the different diseases, 
which will be found in Chapter XL, should invariably 
be followed. Any boarding-school in which there is an 
extended outbreak of diphtheria, scarlet fever, or other 
dangerous infectious disease ought to be closed unless 
there are exceptional facilities for isolation and treat- 
ment. 

Any other matters connected with school-life can better 
be treated of when we consider the School-room in a later 
chapter. 



CHAPTER IX. 

THE BABY'S NURSES. 

During the period of life in which the baby needs 
especial care it may come under the attention of four 
sorts of nurses: (i) the monthly nurse; (2) the wet-nurse; 
(3) the child's nurse or nurse-maid; and (4) the trained 



THE BABY'S NURSES. 1 83 

nurse in case of sickness. We must briefly consider these, 
and the qualities to be desired in each. 

I. The Monthly Nurse. 

Although the monthly nurse is really the nurse for the 
mother, yet it is upon her that the care of the baby 
depends during the earliest period of its life. She it is 
who washes and dresses the child during the time the 
mother is confined to bed, and who watches its condition 
and reports this to the attending physician. 

The choice of the monthly nurse is a matter of the 
greatest importance for both the mother and the baby. 
The physician in charge of the confinement may wish to 
recommend some one on whom he can depend, and in 
this case the entire responsibility rests upon him. If, 
however, the selection is left to the mother, she should 
choose one not so much because she knows her name as 
the nurse of Mrs. So-and-so as because she has, if possi- 
ble, some knowledge of her real ability. Many monthly 
nurses, and particularly the older ones or those who have 
not had careful school-training — and sometimes, un- 
fortunately, even those who have and who might be 
expected to know better — are filled with all sorts of 
wrong ideas about the care of the new-born child. Not 
only so, but they consider their "experience" so great 
that they become obstinate and self-willed, and incapable 
of receiving advice or even of obeying orders. They will 
follow their own plans with the baby, on the ground that 
its care is their business, and not the doctor's. Every 
physician has seen instances of great damage done in this 
way. A truly well-trained nurse has not only been 
taught the proper care of the mother and infant, but has 
learned also that she is to modify her methods promptly 
and silently according to the directions of the physician 



1 84 THE CARE OF THE BABY. 

in charge. In such a nurse the mother may put the 
greatest confidence. 

The nurse should be engaged some months in advance, 
and all pecuniary arrangements made in detail. It is a 
good plan to have her in the house a week or so before 
the confinement is expected, or, if this is not possible, 
then within easy reach, so that she may be sent for with 
the very first signs of beginning labor. She ordinarily 
stays for a month or more after the birth of the child, but 
so long a time is not always necessary. 

It is the custom for the nurse to sleep in the room of 
the mother, or, still better, in the adjoining room. In 
the latter, too, she can take her meals if it is desirable. She 
is to take full charge of the baby, determining the hours 
for feeding, and preparing its food should the mother 
be unable to nurse it herself. She is not ordinarily ex- 
pected to do any washing of the baby's clothes, except, 
perhaps, the diapers, nor to wash her own garments. She 
should be able to prepare special articles of sick-diet for 
the mother, in case there is need for her to do so. 

2. The Wet-nurse. 

The second variety of nurse with which we sometimes 
have to do is the wet-nurse. The advantages and disad- 
vantages connected with the employment of a nurse of 
this kind have already been spoken of when considering 
the Feeding of the Baby in Chapter VI. When it is 
found desirable to nourish a baby in this way the choice 
of the wet-nurse is a matter of great importance. For- 
tunately, this also can often be left entirely to the phy- 
sician in charge. It is absolutely necessary that the 
wet-nurse be in good health, strong, and not too fat. 
A most careful examination on the part of the physician 
is required, since nearly any form of ill-health impairs 
the quality of the milk, and there are some diseases, 



i 



THE BABY'S NURSES. 1 85 

such as syphilis, which can be transmitted directly from 
the nurse to the child at the breast. An examination of 
the nurse's baby is also a guide to the health of its 
mother and to the nutrient value of her milk. 

The nurse should preferably be from twenty to thirty 
years of age. It is better that her own and her foster 
baby be of approximately the same age. It is well if her 
own child is several weeks old, in order that a tendency 
to the early drying up of the milk need not be feared. 
Her breasts should be firm and conical in shape if it is 
her first child, or only very slightly pendulous if she has 
had several children. They should contain plenty of 
milk, as shown by the ability to press some from them 
after the child has done nursing. They should, however, 
become distinctly more flabby when emptied. If they 
do not, their size may depend simply upon their being 
covered by a large amount of fat. The nipple should 
project well and be free from cracks. 

The moral character of the wet-nurse cannot be disre- 
garded. She should be amiable, temperate, and with a 
lively sense of the responsibility of her position. If 
otherwise, the health of the child is sure to suffer. If 
she gives way to violent anger, her milk may become for 
the time actually poisonous, and produce colic, diarrhoea, 
convulsions, or even more serious results. If intemper- 
ate, she may while intoxicated allow the child to suffer 
injury; and if she is irresponsible in any other way, she 
may surreptitiously feed the child with cow's milk if her 
own diminishes, give it an opiate if it does not sleep, 
neglect the care of its body in some manner, or abandon 
it without warning. 

A married woman is to be preferred, but the difficulties 
connected with obtaining a good wet-nurse are so great, 
and married wet-nurses often so scarce, that it is folly to 



l86 THE CARE OF THE BABY. 

refuse to engage an unmarried one if she is qualified in 
other respects. Because she has made one so false a step 
does not prove her wholly bad. We must remember that 
we are not seeking examples of morality or instituting 
rewards for virtue or punishments for crime, but are 
simply trying to obtain a suitable manufacturer of human 
milk for a child who will suffer without it. This remark 
applies, however, only as regards the first illegitimate 
child. A woman who has had more than one child ille- 
gitimately will probably be depraved in other respects 
and be unfit to be trusted. It is only through the danger 
of neglect, however, that the moral vices of a wet-nurse 
affect her foster child. There is no more probability of 
a baby imbibing the character of the nurse through the 
milk which she gives, much as we hear this talked about, 
than there is danger of a child learning to "moo" 
because it is fed on cow's milk. 

It is necessary to regulate carefully the wet-nurse's 
diet, and her method of living in general, according to 
the principles which have been determined in a previous 
chapter to be of service to the health of the nursing 
mother (pp. 113-117). The nurse must have plenty of 
exercise in the open air, sleep in a well-ventilated room, 
and be provided with an abundance of digestible, nutri- 
tious food. At the same time we must remember that a 
w^oman taken from the lower walks of life and given un- 
restrained opportunity to indulge freely in food to which 
she has not been accustomed is ver}' apt to eat too much 
and to exercise too little. Indigestion follows as a 
natural result, and the health of the nurse suffers and 
her milk diminishes or even disappears. The use of 
stimulants by the wet-nurse is seldom necessar}'. A 
woman whose health demands them is not in a fit con- 
dition to fill the place. 



THE BABY'S NURSES. 1 8/ 

Finally, the wet-nurse must be made to adhere to the 
rules for nursing laid down in a previous chapter (Chap- 
ter VI.). But however well qualified the nurse may seem, 
a wise mother will not hand over the care of the baby 
entirely to her, but will exercise a careful supervision 
over everything that goes on, particularly at night. 

3. The Nurse-maid. 

The third form of nurse, and the one whose qualifica- 
tions deserve especial attention, is the ordinary child's 
nurse. Scarcely anything is more diflficult than the 
obtaining of a thoroughly good child's nurse, scarcely 
anything more important to the child, and yet scarcely 
anything more carelessly done. Many a mother en- 
gages a woman of whom she knows practically nothing, 
and transfers to her, blindly and completely, the care of 
the baby. To say that this is all wrong is easy; to ob- 
viate it is difiicult 

Mothers often state with great reason that one can- 
not expect all the virtues for three or four dollars a 
week, and with this fatalistic salve to their consciences 
let the matter rest; but the ill results of this indifference 
are not, however, so easily escaped, and will sooner or 
later show themselves in some way. 

A mother should first consider carefully what qualities 
are to be desired in a nurse-maid, and then exert her 
efforts to discover one who possesses them. Finally, 
after she has obtained the ''invaluable girl" it is most 
important of all never to trust her. Even could the 
nurse's good intentions be relied upon, her knowledge 
and judgment are liable to be deficient, however honest 
she may be in her efforts to do her best. By this it is 
not meant that the mother dare appear openly distrustful, 
since such a course would discourage the best nurse, but 



1 88 THE CARE OF THE BABY. 

rather that she must, as a matter of course, give a con- 
stant supervision, and make it understood that she her- 
self is the chief, and not the second, in the care of the 
baby. It is her duty to her child to be secretly a spy 
upon the nurse, disagreeable as the situation is. 

The entire confidence which mothers often repose in 
their nurse-maids is a matter of wonder to others, and 
sometimes of indignation. Instances are too common in 
which a stranger, moved to pity by seeing a baby wofully 
neglected or abused, has with pure disinterestedness 
reported the case to the mother, only to be met with the 
haughty answer, ^' I have every confidence in my nurse." 
Nurses are constantly seen in parks and other public 
places absorbed in reading, or chatting unconcernedly 
with each other or with some of their male friends, while 
the babies lie crying in their carriages, perhaps exposed 
to the full rays of a hot sun or unprotected from a cold 
wind. Many a time we may see an old woman support- 
ing a crying child on her knee and joggling it roughly 
up and down to the sound of some crooning ditty until 
one would think that its poor little head must ache, and 
its teeth, if it has any, must be loose in its jaws. The 
bad effects of such treatment have already been referred 
to in the preceding chapter. How often, too, are babies 
taken by nurses on their shopping expeditions, or even 
to the houses of their friends, where they are perhaps ex- 
posed to some dangerous contagious disease! 

Seeing, then, how important the choosing of the nurse- 
maid is, we must review some of the qualifications which 
she should possess. This applies not only to her physical 
qualities but to her mental and moral characteristics as 
well, since the child is liable to have its mind and dispo- 
sition moulded largely by its nurse, and it is mani- 
festly impossible for it to attain the qualities so much 






THE BABY'S NURSES. 1 89 

to be desired if its constant pattern is the reverse of 
them all. 

In the first place, the nurse must be in good health. 
The existence of any disease, and especially of consump- 
tion or other form of tuberculosis, should be an absolute 
disqualification. The employment of a nurse with 
syphilis must also be carefully guarded against. Such 
conditions as offensive nasal catarrh, bad breath, pro- 
fuse odorous perspiration, and the like, although not 
actually dangerous to the child, render the presence of 
the nurse very unpleasant. 

There is some question regarding the best age for a 
nurse to be. In general the age of thirty to forty-five 
years is to be preferred. Half-grown girls are seldom fit 
to have the charge of a child entrusted to them; young 
women are very liable to give too much attention to en- 
joying themselves with their friends; while old women, 
although sometimes invaluable, are as a class prone to be 
self-opinionated and forgetful. Of course there are nu- 
merous exceptions to this statement. 

The nurse should be strong. If delicately and slightly 
built, the carrying of the baby for hours at a time 
will be beyond her strength. If, on the other hand, 
she is very stout, she will be able to do little more than 
support her own weight when walking. Besides, the 
mass of her flesh is very heating to a baby held in her 
arms or lap in hot weather. 

The comeliness of the nurse is a matter of comparative 
indifference. Children are apt to think that all those 
whom they love are beautiful. If only the nurse loves 
her charge and has features not actually repelling, more 
is not needed. Even babies in arms perceive the loving 
and trust-inspiring expression and are contented. 

This sincere love of little children is one of the o:reat 



190 THE CARE OF THE BABY. 

requisites of a good nurse. She should have chosen her 
work, not because it offered as good a way as any of 
gaining a livelihood, but because she prefers it to any- 
thing else. If the love be present, other good qualities 
will not be entirely wauling. A devoted nurse will not, 
for instance, easily lose her patience or become angry 
with the child, even though it is really annoying. 

Two other qualities which are very important are in- 
telligence and docility. The nurse should have sufficient 
intelligence to be able to understand, remember, and 
carry out any instructions given her, and should be docile 
enough to be glad to do this, no matter how much pre- 
vious experience she has had. Experience is, of course, 
of the greatest value, yet experience without docility is 
especially to be shunned. A nurse of this character is 
as hard to mould as a stone, and can be taught abso- 
lutely nothing. Better far an intelligent though inex- 
perienced woman who is willing to learn. 

Truthfulness and conscientiousness on the part of the 
nurse are greatly to be desired, but, unfortunately, far 
too rare. How is it possible for a child to be taught by 
its parents the sin of lying and the importance of obedi- 
ence if it constantly hears its nurse teiiing falsehoods 
and sees things done which have been posit' xor- 

bidden? Then, too, the baby may be saved mu^ii suffer- 
ing if the nurse has the courage to admit when she does 
not know, and to report promptly any alteration in the 
child's health or any accident which may have befallen 
it, even though this may have been the result of her own 
carelessness. 

A cheerful and lively disposition is very important, 
particularly when the baby reaches the age when talking 
commences. It sometimes happens that a child's mental 
faculties develop ver)^ slowly if it is much with a nurse 



THE BABY'S NURSES. I9I 

who is very quiet and makes no effort to teach it, but 
that they at once take on a rapid growth when one of 
different disposition is substituted. 

The possession by the nurse of good manners and 
gentleness of disposition, and of a control of good lan- 
guage, is of great advantage when it can be obtained. 
Children will thus learn instinctively to be polite and 
kind. A rough, boisterous, ill-mannered child is the 
natural outcome of association with a coarse-natured, 
loud-voiced nurse. Yet mothers often seem to overlook 
this very obvious fact. 

Finally, the nurse must be cleanly in her person and 
dress, temperate, methodical, and neat. A woman who 
does not keep herself clean cannot be expected to care 
properly for the cleanliness of her charge or to see that 
the nursery is kept free from dirt. So, too, if she has 
not habits of neatness, method, and order there will be a 
constant state of confusion in the nursery, nothing will 
ever be in its place, the baby's clothing will always be 
out of repair, and, especially if there are several children, 
her work will always be behindhand. 

The difhculty attending the procuring of nurses who 
are in any sense qualified for their position and who can 
be at alMrusted is very great, inasmuch as nurse-maids 
frequently come from the ignorant and untrustworthy 
classes. To obviate this difficulty the plan of having a 
jiursery governess is sometimes followed with advan- 
tage, especially where there are several children in the 
family. The occupant of such a position should be ex- 
perienced in the care of children, intelligent, well-edu- 
cated and refined, and capable of teaching the rudiments 
of an education to children who have not yet been sent 
to school. In some cases she may have under her super- 
vision an ordinary nurse-maid, and it should be her 



192 THE CARE OF THE BABY. 

Special duty to see that the children receive proper care 
from the maid. Such a woman expects and should 
receive greater remuneration than an ordinary nurse- 
maid, and can hardly be asked to take her meals with the 
domestics. Her position in the household is, indeed, an 
anomalous and often inconvenient one for all concerned. 

The excellent plan of having training schools for 
nurse-maids was devised some years ago, and has been 
put into successful ])ractice in several of our cities. A 
further carrying out of the scheme in other places is 
much to be desired, for it would help largely to do away 
with the present very perplexing nurse problem. 

Having dealt with the nurse's qualities, we have still 
to consider, first, the nurse's duties to the child, and, 
second, the mother's duties to the nurse. 

The nurse is generally expected to take as complete 
charge of the child as the mother chooses. She washes 
and dresses it, prepares its food if it is on the bottle, and 
takes it out for its airing, either in her arms or in the 
perambulator as the mother wishes. She sleeps in the 
room with it and attends to it at night, or, if the baby 
sleeps in the mother's room, arises when called and gives 
it any attention that may be required. She reports 
promptly the slighest evidence of illness. As the baby 
grows she endeavors to train it mentally and morally, 
enforcing obedience, politeness, neatness, and the like, 
on the lines already indicated. Possibh^ the repairing 
of the child's garments is assigned to her. 

There are certain things which the nurse should be 
distinctly instructed that she shall not do, and some of 
these ^'dont's" the mother may profitably take to her- 
self as well. She should never be impatient or cross 
with the little one. She should never omit to say 
"please" and "thank you" if she asks a favor of the 



THE BABY'S NURSES. 1 93 

child, else the use of the words on its part cannot be 
expected. She should never use harsh commands or 
rough language of any kind. She should endeavor to 
exact implicit obedience on the part of the child, but she 
should also never show anger or take the punishment 
into her own hands, except such harmless, not corporal 
forms as the mother distinctly permits — for example, the 
taking away of a doll, the making to sit in a corner, etc., 
but never the shutting in a dark closet. She must never 
give any object to a child old enough to talk simply 
because it cries for it, but must insist upon being asked 
politely for it. She should teach a child to have no fear 
of harmless objects by herself never showing fear. She 
should never frighten the child in the slightest degree. 
A nurse who tells a child a ghost-story or who makes it 
fear the dark is little short of a criminal, and deserves to 
be punished as such. 

On behalf of all physicians, since their labors with 
children are not easy at the best, I do strongly urge that 
neither mother nor nurse ever hold up the doctor as a 
bogy who will give some bad medicine or take the child 
away if it does not obey some command which has been 
given. Such a course destroys the child's trust in and 
fondness for the physician, and renders his examination 
and treatment of it when sick far more difficult. 

The nurse should never administer a particle of medi- 
cine unless told to do so by the mother, and never give 
food solely for the purpose of quieting a child if crying. 
She should never use baby-talk to a child learning to 
talk, as this retards its acquiring of distinct speech. 

Finally, she must never allow the baby to lie or sit in 
the hot sun or in a windy or damp place, and she should 
not take it into a shop or a private house without the 
mother's consent. 

13 



194 THE CARE OF THE BABY. 

What, now, are the mother's duties to the nurse? 

Chief of all is that of paying her well if she is worth 
it — and she should not be employed if she is not. The 
baby is far too precious to allow of hesitation in this mat- 
ter. The mother should avoid imposing duties upon her 
which do not belong to her, for if she is a faithful nurse 
she will have enough to do to attend to her own affairs. 
She should see that the nurse has full opportunities to do 
her shopping and to see her friends unattended by the 
baby, since this removes the temptation of taking it with 
her. While openly assuming the entire guidance of the 
baby's life, and secretly watching that her directions are 
properly carried out, the mother must show^ no sign of 
distrust, and must endeavor to enlist the interest and 
win the affection of the nurse. 

Finally, she must act with the nurse, and not against 
her, in the management of the children, always upholding 
the nurse's authority before them, even though she after- 
ward explain to her in private that she differs with her, 
and wishes in the future that some other line of action 
be pursued. 

A word with regard to French and German nurses. 
If it is a difficult matter to find a thoroughly good nurse 
among the large number of English-speaking nurses, 
how much more among the much smaller number of 
French and German ones who present themseh'es! If a 
mother desires to employ one of foreign race, she should 
first of all see that she has the qualities of a child's nurse. 
That the child learn a foreign language is far less im- 
portant than that it be well cared for in body and mind. 
Moreover, there is a very strong temptation, hard to 
resist, to insist upon the child spending almost all its 
time with the nurse, in order that it may have the 
greatest opportunity to acquire her language. Xo 



THE BABY'S NUJ^SES. I95 

mother who loves her little one can afford to run the risk 
which this entails. 

4. The Trained Nurse. 

The nurse trained especially for the care of the sick is 
the last one of the baby's caretakers to whom we must 
turn our attention. In cases of slight illness, or even in 
more serious disease, the mother with the help of the 
nurse-maid may be able to carry out the directions of the 
physician without outside help. Often, however, this is 
almost impracticable. A sick child demands the constant 
attention of some one, and it is frequently an utter im- 
possibility for a mother to attend properly to the patient 
and to look after her other duties. Moreover, of all 
things, experience is to be desired in the care of sick- 
ness, and a young mother has usually had no chance to 
acquire it. 

Fortunately, in many of the larger cities a skilful 
trained nurse can now be readily obtained. Such a nurse 
is more than a luxury. She brings with her the great- 
est comfort to the inexperienced mother and increased 
chances of recovery to the child. Unless the expense 
absolutely forbids, every child who is or who is likely to 
become seriously ill should promptly be provided with a 
trained nurse. A good nurse is just as important as a 
good doctor — yes, even more so, for the skill of a doctor 
cannot avail unless his directions are carefully carried 
out. The mother's anxiety and her disposition to yield 
to the child's wishes greatly interfere with her judgment 
and her ability to nurse properly. 

The employment of a nurse, however, does not mean 
that all authority is to be taken from the mother. The 
child is hers; her duty to it remains the same, and she is 
still mistress in the house. The nurse is her employee, 



196 THE CARE OF THE BABY. 

and will obey her directions if she gives them. At the 
same time, the nurse is directly answerable to the phy- 
sician, and dare not, if she is faithful, disobey his orders. 
As she has been engaged to assume the responsibility of 
the nursing and to exercise her trained skill in the care 
of the child, the mother will be chary of interfering, 
unless she sees to a certainty that things are not going 
well and that the nurse is not as competent as she ought 
to be; and even then she had better talk the matter over 
with the physician first. 

The special qualifications of a trained nurse are beyond 
the province of this volume, and can be referred to but 
briefly. The nurse should have been thoroughly taught 
in a training school connected with a good hospital, 
and she should have had special experience in the nurs- 
ing of sick children. Many a nurse is excellent with 
adults, but does not possess the peculiar knack of caring 
for a sick child. An old woman who has merely gathered 
together a lot of useless or harmful theories and practices 
may have had a deal of "experience," but it may only 
have confirmed her in her fatal mistakes. Such a woman 
is to be avoided carefully, as she is no more a trained 
nurse than an "herb doctor" is a physician. This by 
no means implies that all elderly women without hospital 
training are worthless, for many of them are excellent. 
Still, a hospital nurse is usually to be preferred. 

A trained nurse should be young and strong, docile, alert, 
self-possessed, and gentle of hand, step, and voice. She 
should be neat in appearance and very clean. She will 
wear wash-dresses, slippers, and a nurse's cap, all of which 
are not intended as a mark of her office only, but have 
their distinct purposes of cleanliness and quiet as well. 
Her experience should have taught her to observe care- 
fully the different evidences of disease, which we shall 



THE BABY'S NURSES. 1 97 

study in a later chapter, and to understand to a consider- 
able extent what they indicate. If she has been well 
trained and is capable, she will at once take charge of 
the ordering of the sick-room and the diet of the patient, 
and will inspire a feeling of relief in the mind of the 
anxious mother — and of the doctor, too — such as no words 
can express. She will see that the child's food is pre- 
pared properly, and it is her duty even to go into the 
kitchen and to prepare it herself if it cannot be managed 
otherwise. Of course this cannot be done in cases of 
contagious disease, since she must then not go through 
the house to any extent. In diseases of this nature the 
nurse cannot associate with others of the household. She 
must sleep and eat in the sick-room or in an adjoining 
room connected with it, and she should pass through the 
house only on her way out for her daily walk, stopping 
to talk with no one and entering no other room. In 
preparing to go out she should wash her hands thoroughly 
with carbolized water (Appendix, 92) and change her 
slippers for walking-shoes and her wash-dress for her 
street-ofown. After the disease is over she will take the 
proper steps for disinfecting the room. These will be 
described in Chapter X. 

If a mother is herself nursing a child with an infectious 
disease, she must separate herself absolutely from her 
other children, and follow in all respects the rules given 
for the conduct of the trained nurse. 

As with the nurse-maid, there is a duty of the mother 
to the trained nurse. The nurse is not made of iron, as 
seems often supposed, and if she is to accomplish the 
best results for the child she must have regular times for 
sleep and outdoor exercise. Worn out by watching, she 
may easily overlook her duties, administer the wrong 
medicine, or make some other serious blunder. In their 



198 THE CARE OF THE BABY. 

interest in their patients nurses frequently forget this fact. 
The mother must see that the nurse takes sufficient sleep 
and fresh air, that she is well fed, and that her garments 
are laundered for her. 

In very severe and prolonged cases two nurses are 
needed, or the mother must arrange that she or some one 
else take turns with the nurse. 



CHAPTER X. 
THE BABY'S ROOMS. 

However much we may desire to select rooms for the 
baby according to some definite fixed rule, such an 
arrangement is manifestly impossible unless we build a 
house to suit the baby, and then occupy it uninterrupt- 
edly. Frequently not what is best, but what is possible, 
is the plan which must be adopted. This applies par- 
ticularly to those occupying hotels or boarding-houses, 
but even to householders to a considerable degree. The 
advice given in this chapter is intended to be followed as 
closely as circumstances will permit. 

The baby's first room is, of course, that of the mother. 
Here it was born, and here it will probably remain until 
it is several weeks old at least. Later, two rooms should 
be provided for its occupancy — the one for its waking 
hours, and the other to sleep in at night and when taking 
its morning and afternoon naps. These rooms must be 
selected with the greatest care, as they are the most im- 
portant in the house. As the child grows older the selec- 
tion of other rooms is to be considered — namely, the sick- 
room and the school-room. The principles which govern 
the choice of any of these rooms apply equally well in 



THE BABY'S ROOMS. 1 99 

cases in which necessity compels the children to share 
their apartments with other members of the family. 

I. The Day Nursery. 

The position of the day nursery is a matter of much 
moment. As the family can rarely undertake to provide 
one nursery for summer and another for winter, the selec- 
tion of the room must be made with reference to its 
suitability in winter-time, since in warm weather the 
child will be nearly the entire day out of doors, or very 
possibly with the family at a summer resort. It is neces- 
sary, therefore, to choose for the day nursery the brightest, 
airiest room in the house. Sunlight in the room is of 
inestimable value. The exposure should preferably be 
south. If this cannot be had, a room with a window 
looking east is rather better than a westward outlook, on 
account of the presence of the morning sun. A corner 
room with large windows opening south and west is the 
ideal one. Indeed, there should always be more than 
one window if it can be had. In the warm season the 
heat of the sun can be modified by the use of blinds or 
awnings. There may be difficulties connected with the 
heating, or some other conditions which render a certain 
room undesirable, although the exposure is all that can 
be wished. Naturally all the various circumstances must 
be taken into consideration. 

The nursery should not be upon a level with the 
ground, as it is apt to be too damp. The third story is 
the best, provided it is not directly under the roof. More 
light, air, and dryness can usually be obtained at this 
elevation, while the noise in the house is less liable to 
disturb the nursery, or that in the nursery to annoy the 
rest of the house. The room should have as much air- 
space as possible. There ought to be from 500 to 1000 



200 THE CARE OF THE BABY. 

cubic feet for each individual occupying it. The num- 
ber of cubic feet is easily calculated by multiplying the 
length of the room by its breadth, and the result by the 
height. Estimating looo feet as the supply required for 
each person, a room lo feet high, 15 feet wide, and 20 
feet long would accommodate two children and the 
nurse. This does not, of course, mean to the exclusion 
of proper ventilation, and as the number of inmates is 
often greater than this, and the room no larger, or even 
smaller, ventilation must be still more carefully at- 
tended to. 

The ventilation and heating of the room is often a 
difficult problem. Proper ventilation consists in provid- 
ing a constant and abundant supply of fresh air, yet 
without draughts. A house built to accomplish success- 
fully both heating and ventilating will supply fresh w^arm 
air and will remove through ventilators the air already 
used without the necessity of opening a window. Few 
houses, however, are constructed in this way. In a dwell- 
ing as ordinarily built, without this system, an open fire- 
place will furnish a method of removing air that is unex- 
celled, except that it is prone to create draughts upon the 
floor, which must be particularly guarded against. 

Where there is no fire-place a ventilator connected 
with a chimney may be put in the upper part of the wall 
and the foul air removed in this way. Furnace heating 
through flues and a register supplies fresh warmed air 
from without. If fresh air must be admitted from a 
window, it is very important to have it done in a way to 
avoid draughts. This may be accomplished by the use 
of an ordinary ventilating-board. This consists of a 
board 4 to 6 inches high, m^de to fit accurately below 
the lower sash, which \z closed upon it. In this way air 
i-s admitted between the upper and lower sashes. In 



THE BABY'S ROOMS. 



20] 



place of fitting under the lower sash the board may be 
lo or 12 inches high and may be placed against the 
inside of the window-frame. If the lower sash is now 
raised 2 or 3 inches, air enters below and is directed 
upward between the sash and the board, at the same 
time that it also enters the room between the sashes, thus 
producing two currents. An improvement upon this 
arrangement is the apparatus shown in the illustration 




Fig. 41. — Window ventilator: view from inside the room. 

(Fig. 41). The pipes, of which the bent portion is upon 
the inside of the room, serve to direct the cold air upward 
and thus to prevent draughts. By a damper in each the 
amount of air entering can be regulated at pleasure. 
The board itself is of two pieces which slide upon each 
other, thus allowing the apparatus to be fitted under the 
sash in a window of any breadth. This ventilator can 
be obtained of any large hardware or house-furnishing 
store. Another apparatus sometimes used is the revolv- 
ing-wheel ventilator, which may be set in one of the 
upper window-panes, and is made to rotate by the pas- 
sage of the air through it. A wooden frame covered 
with cheese-cloth or thin muslin, and made to fit in the 
window like a fly screen, admits air freely but checks 
draughts, and is sometimes useful. 

Besides this constant ventilation "the room must be 
aired thoroughly with wide-open windows once or twice 



202 THE CARE OF THE BABY. 

a day, at a time when the child is absent, and then be 
well warmed before it is used again. 

For heating the nursery probably nothing as yet takes 
the place of a good hot-air furnace, since this is both 
easily controlled by opening or closing the register, is 
more efficient in cold weather, and aids ventilation by 
supplying fresh warm air from without. The air, it is 
true, is often too dry, particularly when the ordinary 
furnace supplied with drums and hot-air chamber is 
used. It is also liable at times to carry coal-gas with it. 
Air coming in flues from over hot-water pipes is prob- 
ably preferable. The dryness may be modified to a cer- 
tain extent by placing vessels containing water imme- 
diately in front of the register. An apparatus for this 
purpose, consisting of a perforated metal case containing 
a porous pottery vessel of water, and made to hang in 
front of a wall register, has been placed on the market. 

It is a good plan to have the registers rather high in 
the wall, as this puts them where they cannot be touched 
by the children, and tends also to prevent draughts. 

Heating by steam radiators is very effectual, but more 
difficult to control; moreover, it fails to aid sufficiently in 
ventilating. Gas stoves should never be employed unless 
they are supplied with smoke-pipes connected wath the 
chimney or passing through a hole in the window or wall, 
as otherwise they fill the air with the products of combus- 
tion. The open fire-place is the ideal form of heating in 
moderately cool weather, although wasteful of fuel. In 
severe weather, however, it heats too unevenly, making 
one portion of the room very hot and leaving the rest 
cold. The ordinary air-tight coal stove is very service- 
able for heating, but is of little use for ventilation. Cer- 
tain stoves of special manufacture supply ventilation as 
well as heat. It is very important that stoves, fireplaces, 



THE BABY'S ROOMS. 



203 



hot registers, radiators, and all lights in use be so guard- 
ed that there can be no possibility of the baby burning 
itself. A couple of thermometers should be placed in 
different parts of the nursery, away from the windows or 
the heating apparatus, and one of them should certainly 
be near the floor, since the air is often so much cooler 
there, and a child's whole body is so much closer to the 
floor than an adult's is. The temperature ought to be 
kept as uniform as possible, 70° F. being the extreme 
of heat allowed, and 66° to 68° being a much better 
temperature. 

In this connection must be mentioned the fact that in 
cold weather there is always a draught of air from a win- 
dow, even when closed. Weather-stripping will prevent 
some of this, but the greater part of it is due to the chill- 
ing of the air by the cold glass. This is remedied to a 
considerable extent by the use of double sash, but, as it 
is not entirely hindered, it is better in very cold weather 
not to allow the child to play near a window, and per- 
haps not upon the floor at all. 

The furnishing of the nursery should be of such a 
nature that cleanliness can be strictly enforced, partic- 
ularly if the room is to be used at any time as a sick- 
room. 

The floor should be well made, with the boards closely 
joined and smooth, all the cracks and holes stopped with 
putty, and the whole painted or, still better, finished with 
varnish or oil in the natural wood ; or if the floor is old 
and poor it may be covered with oil-cloth. Carpeting of 
some sort is an essential, but it had better not be tacked 
to the floor. If made in the form of one or more rugs, 
both they and the floor can be cleaned more easily. 

The walls of the room are best painted a bright, cheer- 
ful tint, and the ceiling likewise. If paint cannot be used, 



204 THE CARE OF THE BABY. 

a wall-paper may be chosen which can be washed. Paper 
of this nature, coated with a sort of varnish, can readily 
be obtained. It will bear sponging with plain water, 
but soap may injure it. The wall-paper ought not to con- 
tain colors made with arsenic, and any old paper ought to 
be removed previous to repapering. Some large open 
shelves against the wall are a very great convenience. 
Bright-colored, cheap pictures may adorn the room. 
More expensive ones are to be tabooed, since circum- 
stances may arise, such as the occurrence of some con- 
tagious disease, which may render it advisable to destroy 
them. 

An important matter is the fitting of all windows with 
firm bars to prevent the children from falling out. There 
should also be a swinging or sliding gate in the doorway 
to keep the baby from reaching the stairway. The latch 
to the gate must, of course, be out of reach, on the side 
away from the nursery. 

The furniture of the nursery should be strong, light, 
plain, and easily cleaned. Upholstered pieces are not 
desirable. Both large and small chairs, with and without 
rockers, are needed, and a low table at which the chil- 
dren can play and, if desired, take their meals. None 
of these articles should have sharp corners, and the rock- 
ing-chairs are better if of the swinging style without visible 
rockers. "There is also needed a ''nurser}' chair" — a 
little wicker or wooden chair with a hole in the seat and 
a place for the proper vessel below. This chair should 
never be used for any other than the one purpose. A 
tall light screen is a very serviceable article for the cut- 
ting off of lights and draughts. 

Much of what has been said sounds as though the nur- 
sery were to be a bare and ugly room, but this is far from 
being the case. There is a large range for the exhibition 



THE BABY'S ROOMS. 205 

of taste in furnishing. The carpet may be as pretty as 
one wishes, although it had better be inexpensive. 
Painted walls can always be made to look well if the 
tints are good. In addition, the room may be provided 
with a canary bird, the pictures referred to, a globe 
of gold-fish, some growing plants, and similar objects. 
Such a nursery, when occupied by a child happy with its 
toys, cannot but present as pretty a sight as one could 
desire. It may be said here that growing and flowering 
plants, with possibly the exception of those producing a 
heavy odor, are never injurious in the nursery, either by 
day or by night, and are perhaps even beneficial. 

The nursery should be kept scrupulously clean. Be- 
sides the daily dusting, the rugs should be taken up once 
a week, and the floor, as well as the furniture and wood- 
work in general, washed with a damp cloth. The wiping 
off" of the walls from time to time must not be forgotten. 
No food or empty dishes or nursing-bottles should be 
allowed to stand about, and soiled diapers or receptacles 
containing urine or evacuations from the bowels must be 
promptly removed. Closets should be inspected fre- 
quently, lest something unpleasant have been put away 
in them. In fact, every precaution must be taken to 
keep the air sweet and clean. 

The effort to preserve the air pure suggests the question 
regarding the stationary wash-stand. There is a great 
prejudice among many against them. A well-trapped 
stationary wash-stand fitted with the best modern traps, 
and with additional careful trapping of the main drain- 
pipe of the house before it passes to the sewer, is probably 
entirely devoid of danger if flushed often and if inspected 
by a good plumber at frequent intervals. Nevertheless, 
since severe sickness mav result from draining^ which is 
not so perfect, it is sometimes thought better to have no 



206 THE CARE OF THE BABY. 

plumbing at all in either the day or the night nursery. A 
wash-stand of doubtful plumbing may either be plugged 
with putty or, still better, cut off from the sewer. 
Any wash-stand may be made perfectly safe by having it 
empty through a special pipe not connected with the 
sewer in any way. It may, for instance, discharge into the 
rain-water pipe from the roof, provided this does not join 
the sewer, as so many of them do. The latter arrange- 
ment would be far worse than the ordinary one. 

Wash-stands should be kept perfectly clean, and never 
used as slop-sinks. They should be washed frequently 
with a strong soda-solution, ammonia, or a solution of 
copperas or carbolic acid (Appendix, 92). This will 
deodorize the pipe on the room side, but does no good 
whatever as a disinfectant if the plumbing is imperfect. 

2. The Night Nursery. 
In the numerous cases in which a family cannot arrange 
to set aside a room especially for the night nursery, the 
children must sleep either in the day nursery or in the 
mother's room. Indeed, where there is but one child 
a nieht nurserv is hardlv needed, but where there are 
several children in the house, attended by a nurse, it is a 
very great convenience. The night nurser}' should be 
used whenever the children sleep, whether by night or by 
day. The qualifications necessary for it are to a consid- 
erable extent those desirable for the day nursery. Since it 
is so strongly advisable that a mother keep some w^atch 
over her children at night, the night nursery ought to be 
somewhere near the mother's room — indeed, connected 
with it if possible. Ventilation must be provided for at 
night in the manner already described for the manage- 
ment of the day nursery. The sleeping-room should 
also be thoroughly aired after each occasion on which it 



THE BABY'S ROOMS. 207 

is used, and then warmed again to remove all traces of 
dampness. The temperature at night should be 60° to 
65° F. It is not Lest to throw the windows widely open 
and to allow the children to sleep in a cold room. Such 
a procedure is exceedingly likely to bring on catarrhal 
troubles. 

The furnishing of the sleeping-room is similar to that 
already described for the day nursery, as regards the 
floors, walls, carpet, and the simplicity of furniture. 
There should be in it several chairs, a bed for the nurse, 
and one for each of the children. The beds must be 
carefully placed to be out of all draughts. The use of 
folding screens is often a great aid to this end. 

The bath-tub and other articles for the toilet may be 
kept either here or in the day nursery, according as it is 
found most convenient to make the children's toilet in 
the one or the other place. This applies also to the chest 
of drawers which contains the clothing. Should the 
night nursery be used for the morning toilet of the chil- 
dren, the temperature should be elevated to 68° or 70° F. 
before it is performed. 

In the lighting of the night nursery it is to be remem- 
bered that the burning of any ordinary light con- 
sumes a great deal of oxygen in the room, besides 
filling the air with harmful substances. One ordinary 
gas-burner uses per hour as much pure air as several 
adult persons. Nevertheless, artificial light of some sort 
is a necessity in the mornings and late afternoons of win- 
ter. Gaslight is probably the least objectionable kind or- 
dinarily to be had, but if the gas furnished is of bad qual- 
ity the products of its combustion will be more than usu- 
ally harmful. In such a case oil lamps or candles should be 
used — as, of course, they must be where there is no gas 
in the house. Ordinarily, oil is not to be preferred, 



2o8 



THE CARE OF THE BABY. 



because it is much more dangerous from the chance of 
the lamps exploding or of being upset by children. 
When it is possible to do so, it is a good plan to have the 
lights placed immediately beneath a pipe which is con- 
nected with the chimney. This will carry off the prod- 
ucts of combustion, although it does not, of course, pre- 
vent the consumption of oxygen. Nothing equals elec- 
tric lighting for a nursery, since it is not only less hot, 
but consumes no air at all and is destitute of danger to 
the children. 

It is better that children be accustomed to sleep with- 
out light in the room. Should it be found necessary to 
have a light all night long on account of the frequent 
rousings of the baby, a night-lamp of some form is the 
best. Different forms of this may be obtained at the 
drug-stores. They are so constructed that they will con- 




FlG. 42. — Pyramid night-light. 



tinue to burn faintly during the entire night, and they 
consume a minimum of the oxygen of the air. A good 
form is the "Pyramid night-light" (Fig. 42). It is pro- 
vided with a small glass chimney, which has the advantage 



THE BABY'S ROOMS. 209 

of protecting the flame from currents of air and making it 
steadier. The light is furnished by a small candle, about 
an inch and a half in height and breadth, which is sur- 
rounded by a thin layer of plaster of Paris to ensure entire 
safety. A dark metal shade with an opening on one side 
only may be fitted over the night-light to keep the rays 
from falling upon the sleeping child. When a house is 
provided with an electric current an electric lamp of 
special device, giving but one candle power, can be used 
as a night-light, or the ordinary electric lamp may be 
partially covered by a dark screen. 

3. The Sick-room. 

Ordinarily, either the day or the night nursery must 
serve as the sick-room as well, the choice between them 
depending upon circumstances. Where, however, one 
of several small children in a family is taken seriously 
ill, quiet and careful nursing are required, or, perhaps, 
isolation on account of the disease being of a contagious 
nature. It is then almost a necessity to choose some 
chamber to serve as a special sick-room for the time 
being. The following description is of a sick-room suit- 
able to meet the requirements of contagious diseases in 
particular: 

The room should be large and airy, with plenty of sun- 
light, unless the condition of the child's eyes or of its 
nervous system renders light objectionable. All the old 
ideas about the ' ' darkened room ' ' as appropriate to sick- 
ness are things of the past among intelligent people. 
Even when the eyes are inflamed a great degree of dark- 
ening is not needed if a screen will serve to give suffi- 
cient protection. The room should be at the top of the 
house, if possible, and on an entirely different floor from 
that containing rooms occupied by other members of the 

14 



2IO THE CARE OF THE BABY. 

family, particularly children. All unnecessary articles 
of furniture should be removed, and pictures, curtains, 
and carpetings put away if they have any value. Chests 
of drawers and closets in the room should be emptied of 
their contents. If it is desirable to keep the apartment 
from looking bare, some cheap curtains may be placed at 
the windows, and one or two old small rugs or pieces of 
carpet be laid upon the floor. These may be destroyed 
when the illness is over. Great care must be taken to 
preserve strict cleanliness. The floor and furniture 
should be wiped off" with a damp cloth at frequent inter- 
vals, but no sweeping can be permitted. No empty 
dishes with remnants of food, and no ofiensive articles, 
must be allowed to remain. 

It is difficult, and sometimes impossible, to prevent the 
disease from spreading through the house. Certain pre- 
cautions regarding the room are necessary, but to be of 
value they must be of a radical nature. Vessels contain- 
ing so-called ''disinfectant" substances standing about 
the room are absolutely useless, and simply serve to 
make a bad smell. If the house permits of having 
another room, large or small, opening into the sick-room, 
the task is much lighter. A sheet constantly moistened 
with a disinfectant solution (Appendix, 92, 94) should 
be hung at the outer doorway of this anteroom, and the 
door be kept closed. The windows of the anteroom may 
be kept open most of the time if the weather permits, and 
in this room all plates, forks, spoons, nursing-bottles, 
etc. that have been used may first be washed in ordinary 
water and then placed in a disinfectant solution for a 
time (Appendix, 92). There should be in this room a 
wash-tub filled with this solution, in which all linen used 
about the patient or the bed can soak for some hours. 
After this it may be wrung out and placed in a bucket, 



THE BABY'S ROOMS. 211 

and can then be carried to the laundry without danger 
to the household. Immersion in boilino^ water kills all 
germs. Warming of milk or the preparation of any- 
liquid articles of diet may be done in the anteroom, and 
anything brought from the kitchen or elsewhere in the 
house may be received by the nurse at the door of this 
room and then taken to the sick-room. 

When the illness is over the sick-room and anteroom 
must be thoroughly disinfected. The floors must be washed 
with carbolic acid or corrosive sublimate (Appendix, 92, 
96, 97), and the walls and ceilings, if painted, be treated 
in the same manner. Paper on the walls, if it cannot 
be washed, should be removed and new paper applied. 
The furniture and bedsteads may also be washed with 
the disinfectant solution — avoiding, however, the use of 
corrosive sublimate upon metal. The disinfectant solu- 
tions are very poisonous if swallowed, and must be used 
with care. If the mattresses and pillows are well reno- 
vated by steam and re-covered, they are entirely safe, 
but if they are small and old and can well be spared it is 
best to destroy them. In some of the larger cities the 
health authorities will undertake the thorough disinfec- 
tion of articles of this kind. As a final additional pre- 
caution in disinfecting the room, it has been the custom 
to burn sulphur in it, although it is still disputed how 
effectual this is. The health authorities will attend to 
this also if desired, but the nurse or mother can do it 
just as well. Sulphur fumigators come already pre- 
pared for the purpose, and with printed directions. 
They may be had of the leading druggists. In place 
of these the broken roll sulphur may be placed in a 
tin vessel, slightly moif.tened with alcohol, and ignited. 
Three pounds of sulphur are required for every thou- 
sand feet of air-space in the room. The windows of the 



212 THE CARE OF THE BABY. 

room should be closed tightly, and all the cracks about 
them and the doors, as well as the key-hole, stopped with 
cotton or paper. The pan of sulphur is then floated or 
supported in a tub of water to prevent setting fire to the 
floor, the sulphur is ignited, and the door closed. If the 
sulphur fumigators are employed, the box should be 
placed in a dish half filled with earth. After at least six 
hours the door may be opened, the sashes raised, and the 
room well aired. If it is not possible to have the mat- 
tress and pillows steamed, they should be left in the 
room during the fumigation, first partially opening them 
so that the fumes of the sulphur may penetrate them 
better. 

A much better plan is the disinfection of the room 
with formalin, which is volatilized over a special forma- 
lin lamp, for sale by druggists. Formalin has been found 
to be far superior to sulphur as a germ-destroyer. 

The requirements of the sick-room are, of course, 
modified somewhat if the disease is not contagious. 
There is no need of an anteroom or of moistened sheets 
and the like. It is still useful to have the room well out 
of the way if the disease is one which demands quiet, 
and it is just as well, too, to have no unnecessary furni- 
ture in it. The practice of covering tables and shelving 
with all the bottles and boxes of medicine which have 
been in use since the illness began renders the room very 
imsightly and adds greatly to the evidence of sickness, 
besides opening up the possibility of giving the wrong 
medicine. Medicines no longer wanted should be re- 
moved entirely, and those still in use should be concealed 
in a convenient place. 

The ventilation and heating of any sick-room are mat- 
ters of the greatest difficulty. While fresh air is even 
more important than during health, yet in many diseases 



THE BABY'S ROOMS. 213 

the child is peculiarly susceptible to draughts and to 
changes of temperature. Very often the same method 
of window ventilation can be employed in the sick-room 
as recommended for use in the nursery, provided the 
bed be carefully protected against draughts. Sometimes 
additional ventilation may be secured by covering the 
patient entirely with the bed-clothes and opening the 
windows wide for three or four minutes. This plan, 
however, makes a decided alteration of the temperature 
of the room, and is dangerous in many diseases. It 
should not be done except by the advice of the physician. 
In some cases, as in measles, scarlet fever, or any disease 
of the lungs or bronchial tubes, it often seems impossible 
to open the windows in the slightest degree without 
danger of giving the child cold. Where there is an open 
fire-place or a good ventilator in the room the difficulty 
is largely solved, as either of these will serve to provide 
sufficient ventilation, the pure air entering by the cracks 
of the windows and doors; but even with this method 
we must be on the lookout for draughts, so susceptible 
to them do children with these diseases become. The 
existence of currents of air can be sought for by going 
about the room with a lighted candle or a burning match 
and testing the cracks of doors, windows, closets, wash- 
boards, etc. It is not that we wish to stop all entrance 
of air from these places, since that would interfere with 
the foul air going out. It is only necessary that we place 
the bed so that it is not exposed to the air-currents. In 
the absence of a fire-place, in these susceptible cases, 
ventilation must be procured from an adjoining room 
where the air is kept fresh and warm. 

As a means of rapidly deodorizing a room the burning 
of aromatic pastilles, to be procured in the drug-stores, 
is very serviceable. Burning coffee has much the same 



214 



THE CARE OF THE BABY. 



effect. Of course, nothing of this sort in any way takes 
the place of ventilation. 

In some diseases, particularly those of the throat or the 
lungs, it may be desirable to have the air kept constantly 
moist. This may be accomplished by boiling water in a 
flat, shallow pan over an alcohol flame. If it is desired 
to bring the moisture still closer to the child, water may 
be boiled in a kettle, and a tube connected with the 
spout may be brought close to the face, taking care, how- 
ever, that it is far enough removed to avoid too great 
heat. We do not desire to give the child steam, but 
water vapor. An apparatus for this purpose, known as 
the croup kettle (Fig. 43), may be purchased from the 




Fig. 43. — Croup kettle. Fig. 44.— Steam atomizer. 

instrument-maker or druggist. A ver}' satisfactor}' appa- 
ratus for producing moisture in the room is the steam 
atomizer, for sale by druggists and instrument-makers 
(Fig. 44). The bringing of the vapor close to the patient 



1 



THE BABY'S ROOMS. 



215 



is still further aided by draping a couple of sheets over 
the bed to form a ''croup tcnt^'' so that they fall down 
well about it, and are open at one side only, like a tent 
door (Fig. 45). Broom-handles fastened upright, one at 




Fig. 45. — Croup tent. 



each corner of the crib, and connected by cord at their 
tops, form a framework of the proper height to support 
the tent. Where it is desired to make the vapor aromatic 
with such substances as turpentine, oil of pine, oil of 
eucahptus, and the like, the best way is to pour these 
into the shallow pan of boiling water or the croup kettle 
referred to, being careful to avoid the flame. (See Ap- 
pendix, 98.) 

The temperature of the sick-room should be very uni- 
form, and should be about that of the day nursery. 
When the air is being kept constantly moist the tempera- 
ture should be slightly higher. 

In the sick-room or in the day nursery or night nursery 



2l6 



THE CARE OF THE BABY. 




there should be a medicine-chest or wall-closet. Here 
should be placed such remedies and appliances as a 
mother is justified in using herself. A list of articles 
which should be constantly kept in the medicine-closet, 
ready for use in cases of emergency, will be found in 
Appendix, iii. No dangerous medicine should be 
placed in this closet, except under special precautions. 
Bottles containing laudanum or paregoric, belladonna and 
other poison, or any fluids to be used externally should 

never be placed here unless 
of such a nature that they 
may be recognized readily 
even in the dark. If this 
precaution is not followed, 
some dreadful accident may 
happen. A ''poison-guard" 
may be had in the drug-stores. 
A. I&CSO^ ^^ consists of a little wooden 

^/ ffevV'^ ^^^^ ^^^^^ ^ chain attached 

(Fig. 46). It is to be fastened 
to the neck of the bottle, and 
serves to call attention to the 
fact that the contents are dan- 
gerous, or only to be used ex- 
ternally. There is a still better device, consisting of a 
bottle moulded with points projecting after the fashion 
of cut-glass (Fig. 47). The dangerous nature of the 
contents is perceived the moment the hand touches it. 
All the household medicines and the articles for use in 
emergencies should invariably be kept in the closet, and 
nothing else should be placed there. In this way there 
will be no confusion when a mother wants anything in a 
hurry. Do not keep all the half-used medicines remain- 
ing from what the doctor has ordered at various times. A 




Fig. 46.— Bottle 
with poison-guard. 



Fig. 47.— Poi 
son-bottle. 



THE BABY'S ROOMS. Z\J 

few of them might be of service in the future, but the 
majority were good only for the occasion when ordered, 
and the closet will soon be filled to overflowing with 
them. Do not forget to keep the closet locked, and the 
key in a safe but accessible place. I have known of a 
little child, with a fondness for *' playing doctor," 
seriously drugging the bab>' of the family as a result of 
the neglect of this precaution. 

A ver>' serviceable article for use in the sick-room or 
nursery is a small nursery refrigerator, which serves to 
keep ice or milk or other foods during the night. As 
ordinarily made this consists of a small metal vessel, 
eighteen inches or two feet long, with the lid, bottom, 
and sides of two layers — the outer one of tin and the 
inner of zinc — with a narrow space for air between them. 
A simple method of preventing ice from melting is to 
put it into a tin or wooden pail, around and rising above 
which is a hood of several layers of newspaper. The 
paper is gathered together and tied above the ice. 

Some arrangement for the heating of food at night is 
serviceable during illness. There are various appliances 
made to fit over a gas-jet or on the chimney of an oil-lamp, 
and upon wliich a cup or other vessel may be heated. In 
place of these a small alcohol pocket-stove can be pro- 
cured. A vessel for warming the food has been described 
on page 144. 

4. The School-room. 

Unfortunately, the furnishing and the regulating of the 
school-room are generally beyond our control. We can- 
not here consider at length the method of constructing a 
school-building to furnish the proper light, heat, and 
ventilation so greatly to be desired. It is certain that 
colds, near-sightedness, backache, headache, and various 



2l8 THE CARE OF THE BABY. 

nervous derangements may be expected as the result of a 
defect in the hygiene of the school-room, even though no 
mental overwork be indulged in. If the nursery with 
two or three inmates should be well ventilated, how 
much more important is the ventilation where a large 
number of children are collected in one room! Parents 
should refuse to send their children to a school, however 
desirable in other respects, if it is plainly apparent that 
there are going to be constant draughts on the one hand 
or great lack of proper air-space on the other. 

In rural districts, or even in the city, parents who em- 
ploy a nursery governess may prefer their children to be 
taught at home. In such case the day nursery will often 
be the room chosen, and its fitting qualities require no 
further comment. In other instances several families 
may combine in the employment of a governess, and 
will desire to select in one of the dwellings a room which 
will be suitable for the purpose. On this account a few 
remarks will not be out of place upon some of the re- 
quirements of the ideal school-room, as well as upon 
some of the dangers of an unsuitable room. They may, 
indeed, be useful even to those whose children regularly 
attend school, for the subject is one with which we all 
should be somewhat familiar. One of the most im- 
portant considerations in this connection is the danger 
of the production of spinal deformity. A lateral curv- 
ature of the spine is likely to develop, especially in girls 
with weak muscles, as the result of sitting in school with- 
out proper support to the back, or of improper position 
assumed while writing or while standing at recitation. 
To avoid this deformity it is important that the child 
stand squarely upon both feet when reciting, and espe- 
cially that the desk and chair be of a proper kind. Many 
of these are very harmful, and produce a habit of stoop- 



THE BABY'S ROOM. 219 

ing that may never be recovered from. The chair should 
allow the child's feet to rest upon the floor, and should 
have a back which thoroughly supports the lozver por- 
tion of the spine. This latter feature is of the greatest 
importance, but is very frequently wanting. The upper 
part of the chair-back should slope slightly backward to 
support the remainder of the spine when the child is at 
rest. In some excellent chairs the chair-back does not 
extend as high as the shoulders, since no need of support 
is felt if the hollow of the spine and the part below it are 
properly sustained. The low-backed chair is the only 
form that gives support when the child is writing, since 
it allows of the chair being kept close to the desk with- 
out the elbows hitting anything behind them. 

The desk-lid is often too high, and as a result the right 
elbow is too much elevated. This produces a twist of 
the spine, which after a while becomes permanent as a 
lateral curvature. (Compare illustration on page 280). 
The edge of the desk-lid nearest to the child should 
reach only just as high as the elbows, and should over- 
lap the edge of the seat. The child should face the desk 
squarely, with both arms resting upon it. A desk which 
is too high and is not properly placed not only tends to 
produce deformity of the spine, but also brings the book 
on it too close to the eyes and produces near-sightedness 
as a result. Other affections of the eyes, followed by 
headache and other symptoms, result from the use of the 
eyes in an insufficient light or from facing too bright a 
light. The windows should be at the back of the room 
and upon one side, preferably the left, since this does 
away with trying cross-lights. Of course, the same pre- 
caution regarding the proper arrangement of lights must 
be looked after when the child is reading at home. 

As to the actual size of the school-room required, it is 



220 THE CARE OF THE BABY. 

calculated that there should be 300 cubic feet of air-space 
for every scholar. For a class of forty scholars this will 
require a room 28 by 32 by 13 >^ feet (Lincoln). To make 
this amount of air-space sufficient to keep the room in a 
proper condition it is necessary that the air be completely 
changed six times in an hour. Manifestly an ordinar}^ 
school-room with closed windows and no efficient system 
of ventilation does not accomplish this. No wonder the 
poor children grow sleepy and find study hard work! 



CHAPTER XI. 
THE SICK BABY. 

This chapter, necessarily a somewhat long one, must 
not be viewed as an effi)rt to render a mother capable of 
"doctoring " her own children. Such an attempt would 
be a hopeless one, inasmuch as with the treatment of a 
sick baby the experienced physician often has his hands 
far more than full. It is intended only to impart such 
knowledge as will enable a mother to know whether the 
child is ill, what is probably the nature of its ailment, 
whether she shall send for a physician, what she shall do 
before he comes, and how she shall carry out his direc- 
tions afterward. The actual treatment of disease, except 
of the simplest kind, cannot be considered. It is far 
wiser for the mother to meddle very little with the baby's 
illnesses. 

We may conveniently divide our subject into — 
I. The Features of Disease; 
II. The Management of Sick Children; 

III. The Disorders of Childhood. 






THE SICK BABY. 221 

I. The Features of Disease. 

We have already considered, in Chapter II., the cha- 
racteristics of a healthy baby, often called ' ' the features 
of healthy Bearing these in mind, we can now deal with 
some of the ' ^features of disease.^ ' ' in order that we may see 
what can be learned by close observation of a sick child. 

't\\^ position assumed in sickness is a matter of impor- 
tance. A child feverish or in pain is usually very restless 
even when asleep. When awake it desires constantly to 
be taken up, put down again, or carried about. Some- 
times, however, at the beginning of an acute disease it 
lies heavy and stupid for a long time. In prolonged ill- 
nesses and in severe acute disorders the great exhaustion 
is shown by the child lying upon its back, with its face 
turned toward the ceiling, in a condition of complete 
apathy. It may lie like a log, scarcely breathing for 
days before death takes place. Perfect immobility may 
also be seen in children who are entirely unconscious 
although not exhausted. A constant tossing off of the 
covers at night occurs early in rickets. A baby shows a 
desire to be propped up with pillows or to sit erect or to 
be carried in the mother's arms with its head over her 
shoulder whenever breathing is much interfered with, as 
in diphtheria of the larynx and in affections of the heart 
and lungs. The constant assumption of one position or 
the keeping of one part of the body still may indicate 
paralysis. When, however, a cry attends a forcible 
change of position, it shows that the child was still be- 
cause movement caused pain. Sleeping with the mouth 
open and the head thrown back often attends chronic en- 
largement of the tonsils in young children, although it 
may be seen in other affections which make breathing 
difl&cult. In inflammation of the brain the head is often 



222 THE CARE OF THE BABY. 

drawn far back and held stiffly so. Sometimes, too, in 
this disease the child lies upon one side with the back 
arched, the knees drawn up, and the arms crossing over 
the chest. A constant burying of the face in the pillow 
or in the mother's lap occurs in severe inflammation of 
the eyes. 

The gestures are often indicative of disease. Babies 
often place the hands near the seat of pain: thus in slight 
inflammation of the mouth, such as may accompany 
painful teething, they tend to put the hand in the mouth; 
in earache to place it to the ear; and in headache to raise 
it to the head. In headache or in affections of the brain 
they sometimes pluck at the hair or the ears, although 
they may often do this when there is no such trouble. 
Picking at the nose or at the opening of the bowel is 
seen in irritation of the intestine from worms or from 
other cause. The motion of the hands is often, how- 
ever, deceptive. For instance, a child with pain in its 
chest may sometimes refer it to the abdomen and place 
its hand there. In approaching convulsions the thumbs 
are often drawn tightly into the palms of the hands and 
the toes are stiffly bent or straightened. Ver}' young 
babies, however, are apt to do this, although healthy. 
The alternate doubling up and straightening of the body, 
with squirming movements, making of fists, kicking, 
and crying, is an indication of colic. This is especially 
true if the symptoms come on suddenly and disappear as 
suddenly, perhaps attended by the expulsion of gas from 
the bowel. 

The color of the skin is often altered in disease. It is 
yellow in jaundice, and is bluish, especially over the 
face, in congenital heart disease. There is a purplish 
tint around the eyes and mouth, with a prominence of 
the veins of the face, in weakly children or in those with 



i 



THE SICK BABY. 223 

disordered digestion. A pale circle around the mouth 
accompanies nausea. The skin frequently acquires an 
earthy hue in chronic diarrhoea, and is pale in any con- 
dition in which the blood is impoverished, as in Bright' s 
disease, rickets, consumption, or any exhausted state. 
Flushing of the face accompanies fever, but besides this 
there is often seen a flushing without fever in older 
children the subjects of chronic disorders of digestion. 
Sudden flushing or paling is sometimes seen in disease 
of the brain. 

The expressio7i of the face varies with the disease. 
Young, healthy babies have little expression of any 
kind except that of wondering surprise. In whooping- 
cough and measles the face is swollen and somewhat 
flushed, giving the child a heavy, stupid expression. 
There is also swelling of the face, especially about the 
eyes, in Bright' s disease. Repeated momentary crossing 
of the eyes often indicates approaching convulsions. A 
wrinkling of the forehead often denotes pain. In very 
severe acute diarrhoea it is astonishing with what rapidity 
the face will become sunken and shrivelled, and so 
covered with deep lines that the baby is almost unrec- 
ognizable. The same thing occurs more slowly in the 
condition commonly known as marasjmis. Often the 
face has an expression of distress in the beginning of 
any serious disease. If the edges of the nostrils move in 
and out with breathing, we may suspect some difficulty 
of respiration such as attends pneumonia. The baby 
sleeps with its eyes half open in exhausted conditions or 
when suffering pain. Chewing movements during sleep 
result from disordered digestion, and a smile in very 
young infants often has the same cause. 

The head ^y\\\\AX.'s, certain noteworthy features. Excess- 
ive perspiration when sleeping is an early symptom of 



224 '^^^ CARE OF THE BABY. 

rickets. Botli in this disease and in hydrocephalus (water 
on the brain) the face seems small and the head large, 
but in the former the head is square and flat on top, 
while in the latter it is of a somewhat globular shape. 
(Compare illustrations, Plate III.). The fontanelle is 
prominent and throbs forcibly in inflammation of the 
brain, is too large in rickets and hydrocephalus, bulges 
in the latter affection, and is sunken in debilitated states. 
The disfigurements of the head immediately following 
birth will be described later in this chapter (p. 277). 

The chest exhibits a heaving movement with a drawing 
in of the spaces between the ribs in any disease in which 
breathing is difficult. A chicken-breasted chest is seen 
in Pott's disease of the spine, and to some extent in bad 
cases of enlargement of the tonsils; a "violin-shaped" 
chest in rickets; a bulging of one side in pleurisy with 
fluid; and a long, narrow chest, with a general flattening 
of the upper part, in older children predisposed to con- 
sumption. 

The abdomejt is swollen and hard in colic. It is also 
much distended with gas in rickets, and is constantly so 
in chronic indigestion in later childhood. It is usually 
much sunken in inflammation of the brain or in severe 
exhausting diarrhoea. It may be distended with liquid 
in some cases of dropsy. 

The study of the ay furnishes one of the most valuable 
means of learning what ails a baby. An unremitting 
cry is usually due to hunger, or sometimes to thirst, but 
scarcely any cry is so unappeasable as that of earache. 
We must remember that not every cry that ceases 
when the baby is nursed is caused by hunger. Some- 
times the cry of colic will be temporarily helped in this 
wa}'. Sometimes a persistent Qxy is due to pain of 
another nature — such, for instance, as that caused by the 



THE SICK BABY. 225 

pricking of a pin. It may also be produced by the in- 
tense, constant itching of eczema. 

A paroxysmal cry, very severe for a time and then 
ceasing absolutely, is probably due to colic, particularly 
if accompanied by the distention of the abdomen and 
the movements of the body already referred to. If the 
baby cries every time it is picked up, it is probable that 
the pressure upon the chest while lifting it gives pain. 
This may be the result of rickets or of pleurisy. Crying 
when any one part is touched suggests, of course, that 
there is something wrong there. A sleepy child has a 
fretful cry, often with rubbing of the eyes and other evi- 
dences of its sensations. A freqnent, peevish, whining 
cry is heard in children with general poor health or 
discomfort. A single shrill scream uttered now and 
then is often heard in inflammation of the brain. In 
any disease in which there is difficulty in getting enough 
air into the lungs the cry is very short and the child cries 
but little, because it cannot hold its breath long enough 
for it. A nasal cry occurs with cold in the head. A 
short cry immediately after coughing indicates that the 
cough hurts the chest. Crying when the bowels are moved 
shows that there is pain at that time. A loud, violent cry 
coming on suddenly is very often an exhibition of temper. 
A child of two to six years, waking at night with violent 
screaming, is probably suffering from night-terrors. In 
conditions of very great weakness and exhaustion the 
baby moans feebly, or it may twist its face into the posi- 
tion for crying, but emit no sound at all. This latter is 
also true in some cases of inflammation of the larynx, 
while in other cases the cry is hoarse or croupy. Crying 
when anything goes into the mouth makes one suspect 
some trouble there. If it occurs with swallowing, it is 
probable that the throat is inflamed. 
15 



226 THE CARE OF THE BAB\. 

With the act of crying there ought always to be tears 
in children over three or four months of age. If there 
are none, it is an indication that the disease is serious, 
and their reappearance is then a good sign. 

The character of the cough is also instructive. A long- 
continued, loud, nearly painless cough, at first tight and 
later loose, is heard in bronchitis. A short, tight, sup- 
pressed cough, which is followed by a grimace and, per- 
haps, by a cry, indicates some inflammation about the 
chest, often pneumonia. There is a brazen, barking, 
**croupy '' cough in spasmodic croup. In inflammation 
of the larynx, including true croup, the cough is hoarse 
or even almost noiseless. The cough of whooping-cough 
is so peculiar that it must be described separately. Then 
there are certain coughs which are purely nervous or 
dependent upon remote affections. Thus the so-called 
"stomach cough" is caused by some irritation of the 
stomach or bowels. It is not nearly so frequent as 
mothers suppose. Irritation about the nose or the canal 
of the ears sometimes induces a cough in a similar way. 
Enlarged tonsils or elongated palate may also produce a 
cough. 

The breathing of a young child, particularly if under 
one year of age and awake, is always slightly irregular. 
If it becomes very decidedly so, we suspect disease, 
particularly of the brain. A combination of long pauses, 
lasting half a minute or a minute, with breathing which 
is at first very faint, gradually becomes more and more 
deep, and then slowly dies away entirely, goes by the 
name of " Cheyne-Stokes respiration" and is found in 
affections of the brain. It is one of the worst of symp- 
toms except in infancy, and even then it is alarming. 

The rate of respiration is increased in fever in propor- 
tion to the height of the temperature (see page 229). It 



THE SICK BABY. 227 

is increased also by pain, in rickets, and especially in 
some affections of the Inngs. Sixty respirations a minute 
is not at all excessive for a child of two years with 
pneumonia, and the speed is frequently decidedly greater 
than this. 

Breathing is often very slow in disease of the brain, 
particularly tubercular meningitis. Poisoning by opiates 
produces the same effect. Frequent deep sighing or 
yawning occurs in brain affections, in faintness, or in 
great exhaustion, and may be a very unfavorable symptom. 
Breathing entirely through the mouth shows that the 
nose is completely blocked, while snuffling breathing is 
the result of a partial catarrhal obstruction. A gurgling 
in the throat not accompanied by cough may indicate 
that there is mucus in the back part of it, the result of a 
slight inflammation. "Labored" breathing, in which 
the chest is pulled up by each breath while the muscles 
of the neck become tense, the pit of the stomach and the 
spaces between the ribs sink in, and the edges of the 
nostrils move in and out, is seen in conditions where the 
natural ease of respiration is greatly interfered with, as in 
pneumonia, diphtheria of the larynx, asthma, and the 
like. Long-drawn, noisy inspirations and expirations are 
heard in obstruction of the larynx, as from laryngeal 
diphtheria or spasmodic croup. 

The rate of the pulse is subject to such variations 
in infants that its examination is of less value than 
it would otherwise be. In early childhood its ob- 
servation is of more value, although even then decep- 
tive. Unusual irregularity is an important symptom in 
affections of the brain and of the heart. Fever is accom- 
panied by an increase in the pulse-rate, the degree of 
which depends, as a rule, upon the height of the tem- 
perature (see p. 229). Slowing of the pulse is a very 



228 THE CARE OF THE BABY. 

important symptom, seen particularly in affections of the 
brain, and sometimes in Bright' s disease and jaundice. 

The temperature and the method of determining it have 
already been referred to in Chapter II. It is of all things 
important to remember that in infancy and childhood fever 
is easily produced and runs high from slight causes. Al- 
though a very decided elevation should render a mother 
anxious to discover the cause, there is no reason why it 
should at once throw her into a paroxysm of fright. Even 
slight cold or the presence of constipation or slight dis- 
turbance of digestion may in babies sometimes produce a 
temperature of 103° or more. We do not speak of fever 
unless the temperature reaches 100°. A temperature of 
102° or 103° constitutes moderate fever, while that of 104° 
or 105° is high fever, and above 105° very high. A tem- 
perature of 107° is very dangerous, and is usually not 
recovered from. The danger from fever depends not only 
upon its height, but upon its duration also. A temper- 
ature of 105° may be easily borne for a short time, but it 
becomes alarmiug if much prolonged. 

There is a notable tendency to variation of the tem- 
perature of fever during the day, but, contrary to the 
condition in health, the elevation at night is nearly 
always greater than in the morning. We do not need to 
be discouraged, therefore, should a child whose tempera- 
ture had diminished considerably in the morning have it 
become much higher by the evening. On the other hand, 
should a morning fever be only as high as that of the 
evening before, we may conclude that the tendency to 
elevation is really greater. A sudden fall of temperature 
is usually a favorable sign, but this is not always so, for 
unless it is accompanied by an improvement in the other 
symptoms, it may indicate that death is imminent. The 
various febrile diseases have each their characteristic 



THE SICK BABY, 229 

course with regard to the height, duration, and variation 
of temperature, but the subject is too difficult to be dis- 
cussed in a book of this sort. 

With elevation of temperature from any cause there is 
a corresponding increase of the rate of both pulse and 
respiration. About eight or ten beats of the pulse and 
about two or three respirations may be added for each 
degree of temperature above normal. This ratio is equiv- 
alent to about one additional respiration for each three or 
four beats of the pulse. There are certain diseases, as 
pneumonia, scarlet fever, typhoid fever, and some others, 
where this normal ratio is not preserved. The rates, as 
given, hold good, especially for adult life. It is probable 
that in children the rate of increase of pulse and respira- 
tion for each degree of temperature is somewhat greater. 

Instead of elevation we sometimes find depression of 
temperature below normal. A temperature of 97° or 
less in the rectum is always alarming in children, and 
one of 95° rarely occurs unless the child is dying. 
Exhaustion from any cause, as from profuse diarrhoea, 
obstinate continued vomiting, or hemorrhage, is liable 
to produce a depression of temperature, and some de- 
gree of reduction is always present in babies suffering 
from insufficient nourishment, anaemia, or chronic dis- 
eases of the heart and lungs. So, too, after attacks of 
the various febrile diseases the temperature is liable to 
be below normal for some days. 

The /ojigjie of newly-born infants is generally whitish, 
and continues to be so until the saliva becomes plentiful. 
After this we usually find it coated in disturbances of the 
stomach and bowels and in nearly any disorder accom- 
panied by fever, although not, as a rule, so thickly as in 
adults. Yet we cannot lay so much stress on the coating 
of the tongue in the early years of life as in later years, 



230 THE CARE OF THE BABY. 

for children with perfect digestion often exhibit coated 
tongues, while those with severe intestinal catarrh may 
often have tongues of perfectly natural appearance. In 
scarlet fever the tongue becomes bright red after a few 
days, and in measles and whooping-cough it is often 
slightly bluish. In the latter affection an ulcer' may 
sometimes be found directly under the tongue, where 
the thin membrane binds it to the floor of the mouth. 
In thrush the tongue is covered with white patches like 
curdled milk. A pale, flabby tongue, marked by the 
teeth at its edges, indicates debility or impaired diges- 
tion. In prolonged or very high fever the tongue grows 
dry, and in some diseases of the stomach or bowels it 
may look like raw beef 

Grinding of the teeth is a frequent symptom in infants 
in whom dentition has commenced. It generally indi- 
cates an irritated nervous system. Most often this 
depends upon some disturbance of digestion; less often 
upon the presence of worms. The symptom is present 
during or preceding a convulsion, and may occur, too, 
in disease of the brain. In some babies it appears to be 
only a nervous habit. 

The manner of nursing or swallowing frequently 
affords important information. A baby whose nose is 
much obstructed or who has pneumonia can nurse for 
but a moment, and then has to let the nipple go in order 
to breathe more satisfactorily. If it gives a few sucks 
and then drops the nipple with a cry, we must suspect 
that the mouth is sore and that nursing is painful. If 
it swallows with a gurgling noise, often stops to cough, 
and does as little nursing as possible, we suspect that the 
throat may be sore. The ceasing to nurse at all, in the 
case of a very sick baby, is an evidence of great weakness 
or increasing stupor, and is a most unfavorable symptom. 



THE SICK BABY. 23 1 

Urine that is high-colored and stains the diaper, or 
that shows a thick reddish cloud after standing, may 
accompany fever or indigestion. Sometimes the urine 
under these conditions is milky when first passed. In 
some babies a diet containing beef-juice or other highly 
nitrogenous food will produce this reddish cloud, or even 
actual, red, sand-like particles. A decidedly yellow stain 
on the diaper occurs when there is jaundice. The amount 
of urine passed is scanty in fever, and especially so in 
acute Bright' s disease. In the latter disease the urine is 
often of a smoky or even a muddy appearance. The pos- 
sibility of the occurrence of this symptom after scarlet 
fever must always be kept in mind, in order that a phy- 
sician may be summoned very quickly, since it is a 
serious matter. 

The boivcl-movements characteristic of health have 
already been described. Apart from the various altera- 
tions in appearance seen in diarrhoea and constipation, 
and presently to be referred to, we find that the passages 
are often putty-colored in disorders of the liver, frequently 
tarry in appearance in bleeding within the bowel, and 
liable to be black after taking bismuth, charcoal, or iron. 
Infants who are receiving more milk than they can 
digest constantly have whitish lumps in their stools, or 
even entirely formed but almost white passages. The 
presence of a certain amount of greenish coloration of 
the passages is not infrequent. This is, of course, an 
evidence of indigestion. 

II. The Management of Sick Children. 

Where a trained nurse used to the ways of children can 
be had, the nursing of a sick child will generally go on 
without trouble. Still, no mother ought to be without 
knowledge on the subject^ and the majority need it badly, 



232 THE CARE OF THE BABY. 

in case they must themselves fill the nurse's place. The 
following remarks, although descriptive of the duties of 
a nurse, are intended especially for the mother nursing 
her own sick children. 

One of the nurse's chief cares should be, of course, to 
observe the child closely in the search for evidences of 
disease. Another, and often a very difficult one, is the 
administration of medicine and food. If the child has 
been well trained in habits of obedience, it will take 
what is given to it without much objection. If it is not 
so trained, the nurse must exercise the greatest firmness 
and insist upon being obeyed, or, failing in this, must 
use whatever means of persuasion will most easily attain 
the desired end. Very often the promise of a chocolate 
or other sweet, some pennies, or a simple toy will serve 
to overcome the obstinacy. This, of course, is rank bri- 
bery, and against all rules for moral training. Sickness, 
however, is hardly the time to inculcate principles which 
should have been taught long before, and the taking of 
food and medicine is so important that the end fully jus- 
tifies the means. Should a child still prove obstinate, it 
is better to lose little time in argument or pleading which 
must be repeated several times a day. The nurse will do 
better if she promptly takes the child up, wraps a shawl 
closely about its body and arms to prevent interference, 
holds its nose carefully, and then, when it opens its mouth 
to breathe, inserts the spoon as far as possible, empties it 
gently, and withdraws it slowly. If the spoon is not 
withdrawn, the child has difficulty in swallowing. This 
seems like harsh treatment; still, if it is done without 
excitement or anger, and as a matter of course, the child 
soon looks upon it as inevitable, and will often take its 
medicine quietly, without making a frequent repetition of 
the procedure necessary. In young babies the pressure 



THE SICK BABY. 233 

of the chin backward and downward with the finger will 
often serve to open the mouth. Often an infant who 
spits out the greater part of a teaspoonful of medicine 
will take it very well if given a little at a time. 

Sometimes a child continues to fight so hard that the 
exhaustion following seems to overbalance all the good 
that can ensue. Let the physician be informed promptly 
of the state of the case, and let him have the responsi- 
bility of determining what course it is best to pursue. 
In all giving of medicine there must be the strictest ad- 
herence to truth, and no child must ever be told that a 
disagreeable dose "tastes good." If this course is not 
followed the one dose is all that it will ever take. It will 
feel, too, that it has been imposed upon, and will distrust 
the nurse. In the case of children who lie stupid or semi- 
delirious in bed, and to whom the administration of food 
or medicine in the ordinary way is difiBcult or impossible, 
much can sometimes be accomplished by the use of the 
medicine-dropper. If this be inserted beside the teeth 
and emptied, the contents will usually be swallowed. 
The dropper should not be placed between the teeth, on 
account of the danger of its being bitten. 

Many liquid medicines will be of a disagreeable taste, 
no matter how great care the physician may take in pre- 
scribing or the druggist in preparing. The bad taste 
may be avoided to some extent by letting the child take 
a sip of milk or water, a mint drop, or a suck at an 
orange immediately before and after swallowing. Castor 
oil may be floated on soda-water, ice-water, whiskey and 
water, or lemon-juice. In this way it often tastes very 
little. It is also nearly tasteless if stirred in hot milk, 
but the child must not be deceived as to the nature of 
the drink, or it may turn against plain milk. Cod-liver 
oil is not disagreeable to most children, many of them 



234 THE CARE OF THE BABY. 

even learning to like it. All unmixed oils given from a 
spoon should be warmed in it to make them less thick. 
After taking any acid medicine it is a good plan for the 
child to rinse its mouth with a solution of baking-soda in 
water. This will prevent the teeth being set on edge or 
injured. Small and comparatively tasteless powders can 
best be placed directly upon the tongue and a sip of 
water then given to wash them down. Sometimes they 
may be mixed with a little sugar and taken in the same 
way. If larger, they can be stirred up thoroughly in a 
little jam or scraped apple, provided there is no disease 
of digestion which makes this inadvisable. Another 
good plan is to put a small quantity of sugar in a tea- 
spoon, empty the powder upon this in an even layer, and 
fill up the spoon with sugar. The whole is then moist- 
ened with water and swallowed. Tasteless powders may 
frequently be given in bread and milk or milk toast with- 
out the child perceiving them in the slightest. 

Very young children cannot take pills. Later they 
learn easily, particularly if the pills be placed within a 
little jelly or preserved fruit. It is sometimes a good 
plan to let the child practise with home-made bread pills 
until it learns how to swallow them easily. In giving 
liquid medicines it is important that all doses be meas- 
ured accurately. Teaspoons vary greatly in size, and, 
besides, we cannot determine just when they are exactly 
full. The little glasses marked with "teaspoon" and 
"tablespoon," to be had at any drug-store, are much to 
be preferred. As even these are not accurate, the best 
plan is to procure a four-ounce graduate, such as is used 
by druggists, marked with drachms and ounces (Fig. 68, 
p. 386). In the Appendix (108-110) will be found a table 
of equivalents showing the relative value of tablespoon- 
fuls and teaspoonfuls, ounces and drachms, and so on, a 



THE SICK BABY. 235 

table of dosage for different ages, and a dose-list of some 
of the medicines most frequently given to children. The 
proper doses of the various remedies which may be re- 
ferred to under the different diseases will be found in this 
last table. It must not be forgotten that the drops of all 
alcoholic fluids are much smaller than those of water 
(Appendix, 108). 

Feeding a sick child is even more important than 
giving medicine, and often just as difficult. Where there 
is great loss of appetite it is important to remember that 
the child will sometimes drink all of a small glass of 
milk when it will take much less, or none, of a more 
formidable-looking larger one. A pinch of salt in boiled 
milk helps to take away its disagreeable taste — but it 
should be only a pinch. Under many conditions a little 
sugar may be added. Sometimes a sick child can be 
persuaded to drink milk or to take other food if the nurse 
will take some also. Sometimes milk may be given in 
place of water when the child asks for a drink. Vari- 
ous other expedients dependent upon the individual case 
will suggest themselves to an intelligent, wide-awake 
nurse. 

Three good rules are to be borne in mind in this connec- 
tion: First, never make any experiment with new articles 
of food in the case of children suffering from diseases of 
the stomach or bowels or in typhoid fever; second, at the 
outset of any illness give little or no nourishment; third, 
if vomiting occurs whenever food is given in the course 
of any affection, stop all feeding until the doctor can be 
consulted. A number of prepared foods often useful in 
sickness will be found in the Appendix (Dietary). 

An absurd and still too widespread idea is that a sick 
person must receive a limited amount of water. As a 
rule, and particularly in fevers, all the water that a child 



236 THE CARE OF THE BABY. 

asks for may be given it, provided this does not take the 
place of nourishment. Often the promise of water as a 
reward will induce the taking of some food. Where for 
any reason the amount of water must be restricted, it 
will be found that a child will often be content with a 
small glass provided it is allowed to drain it, while it 
would have clamored for more if permitted to empty a 
large glass only partially. 

Quiet in the room is very greatly to be desired, and 
is often wofully neglected. Babies cannot, and children 
of three or four years do not, ask for it, since they do not 
realize that their headaches and nervousness are the re- 
sults of noise. Visits by friends should be forbidden. 
A sick child should be encouraged to lie in its bed as 
much as possible, although there are some exceptions to 
this. Thus, for instance, when a little patient has some 
disease attended by difficulty in breathing, it is usually 
much more comfortable if allowed to sit in its crib, or 
even if carried in the nurse's arms with its head over her 
shoulder. A weak, exhausted child, or one with fluid 
in the chest, should never be raised rapidly to a sitting 
position in the bed; indeed, all movement is to be 
avoided as far as possible, as it is exhausting or danger- 
ous. A nurse about to move a child with an injured 
limb should always support the member well and keep it 
on the side away from her. A child with hip7Joint dis- 
ease or with disease of the vSpine should be lifted hori- 
zontally, in order to keep the weight of the body from 
pressing on the sensitive part. The position of the 
sick child in bed is of great importance in pneumonia 
or in any disease attended by exhaustion. It should 
be changed frequently from the back to one side or the 
other, to prevent the blood from settling in any one part 
of the lung and to hinder, too, the formation of bed-sores. 



THE SICK BABY. 237 

Many people seem to have an irresistible desire to 
cover children very warmly in bed, no matter how much 
fever they may have or how hot the weather may be. 
This is, of course, all wrong. The covers should be light 
in such conditions, and a child sufficiently old should be 
asked whether it is too warm. A feverish baby should 
never be held long on the lap in hot weather. On the 
other hand, whenever a child is taken up, though only 
for a moment, it should have a wrap thrown about it. 
We often forget, too, that when well enough to be 
propped in bed its arms and chest are more lightly 
clothed than when it is completely dressed. It is folly to 
put a child to bed for a bronchitis and not to guard it, 
by having it wear a light sack, against the danger of 
taking cold. There should be a bed-dress for the night 
and another for the day (see page 109). 

Cleanliness of the body is very necessary in sickness. 
As a rule, the child should be sponged all over once or 
twice a day with soap and water or sometimes with water 
and alcohol, either cool or wann according to circum- 
stances. In cases of diarrhoea careful local washing 
should follow each evacuation of the bowels. Starch- 
water (Appendix, 43) is preferable to ordinary water for 
this purpose, and the application of a dusting powder 
completes the drying. The warm tub-bath can be used 
in many diseases. In the eruptive fevers, however, 
neither this nor sponging should be employed without 
medical advice, since some physicians are much opposed 
to them in diseases accompanied by a rash. It is much 
better at the beginning of any illness to obtain explicit 
directions regarding bathing. 

The bed for the sick child should be comfortable and 
clean. The sheets should be changed often, and the fresh 
ones always warmed before they are used. In cases of 



238 THE CARE OF THE BABY. 

prolonged illness it is a good plan, although not often 
practised, to have two beds, one for the day and one for 
the night. This gives an opportunity for airing the beds, 
and the change is distinctly restful to the patient. A 
draw-sheet or pad of some sort is of service where there 
is any tendency to soiling of the bed. 

After an offensive movement from the bowels fresh air 
is needed in the room as soon as possible. As the throw- 
ing open of the windows is often impracticable, an aro- 
matic pastille or some coffee may be burned. This pro- 
cedure of course does not purify the air in the slightest, 
but it does serve to conceal to some extent the disagree- 
able odor until ventilation can remove it entirely. 

The method of nursing infectious diseases and of disin- 
fecting the room has already been described when treat- 
ing of the Trained Nurse and of the Sick-room in 
Chapters IX. and X. 

Various methods for the external treatment of a sick 
child are often ordered by the physician. Baths are used 
for this purpose as well as for cleanliness. The baths 
may be general or local, hot or cold, applied in the form 
of sponge-baths, tub-baths, wet packs, and other methods, 
and medicated in various ways. Further details of these 
procedures and of their value in disease will be found 
under the heading of Baths in the Appendix (36-50). 

Physicians often order dry heat or moist heat to be 
used locally. The former is applied in the shape of 
hot bottles, bags of hot water, sand, or salt, hot bricks, 
or a hot stove-lid. It is useful where the circulation is 
poor and the temperature of the body is lower than it 
should be. The hot articles should be wrapped carefully 
in flannel to prevent burning the skin. This is especially 
important when the child is unconscious and cannot 



THE SICK BABY. 239 

complain, since serious burns have often been produced 
by carelessness in this respect. Moist heat is of value 
to relieve pain and inflammation. It may be used in the 
form of fomentations or of poultices of dififerent kinds 
(Appendix, 50-62). The former are lighter, but the 
latter retain their heat longer. 

Cold is applied locally, in the form either of cold com- 
presses (Appendix, 50) or of ice-bags, in order to subdue 
inflammation or pain. Ice-bags are made of thin rubber, 
and are of different sizes and forms. The thinner the 
rubber the more easily does the bag adapt itself to the 
shape of the part and the more successfully keep it cool. 
Many of the ice-bags sold in the shops are entirely too 
thick and are practically useless. A pig's bladder filled 
with ice forms an excellent substitute for the rubber bag. 
The bag should be not more than half filled with small 
fragments of ice. If it is too full, it is impossible to 
apply it accurately. Since the moisture of the surround- 
ing air condenses on the bag, dry towels must be so 
placed that the drip will not wet the child. A piece 
of thin cloth must sometimes be placed between the ice- 
bag and the skin to prevent the latter from being frozen, 
but ordinarily this is not needed, and checks the action 
of the cold too greatly. 

The nurse will often be required to make other appli- 
cations, such as mustard plasters, turpentine stupes, spice 
plasters, and the like (Appendix, 63-66). She will some- 
times need, too, to administer enemata for constipation 
or for inflammation of the bowel and diarrhoea, or per- 
haps even to give nourishment in this way. A hard- 
rubber syringe holding four to six ounces and fitted 
with a piston which moves very easily is well suited for 
ordinary use. Another form useful for small injections, 



240 THE CARE OF THE BABY. 

called the Infant's syringe," consists of a soft-rubber 
bulb with a hard-rubber nozzle (Fig. 48). 




Fig. 48. — Infant's syringe. 

In using a syringe the fluid should be drawn into it, 
the nozzle then well greased with vaseline and inserted, 
and the contents expelled very slowly. For giving large 
injections, as in inflammation of the bowel and constipa- 
tion, the ordinary elastic bulb syringe (Fig. 49) or, much 
better, a fountain syringe (Fig. 3, p. 30) is sometimes to 
be preferred. A long rubber tube with a funnel at one 




Fig. 49. — Elastic bulb syringe, 

end and a hard-rubber nozzle at the other makes an 
excellent extemporaneous fountain syringe. As it is 
sometimes difiicult to get a child to retain an injection, 



I 



THE SICK BABY. 24 1 

it is a good plan to wrap a narrow roller bandage firmly 
around the nozzle (Fig. 50). The pressure of the band- 
age against the opening of the bowel helps to prevent 
the fluid from being ejected. Large injections should 
be given very slowly, with the child upon its back or 
its left side. 

It is often necessary for the nurse to make applications 
to the throat. This is best done with a large, straight 
camel' s-hair brush firmly fastened to a straight, stout 




Fig. '-^o. li.ad-rubber syringe with roller bandage on the nozzle. 

stick. The bent brushes or those mounted on wire 
handles are not nearly so easily controlled. Physicians 
often use cotton wrapped on a metal applicator. If the 
child is well trained and of sufficient age, it is simply 
necessary to depress the tongue with a spoon while mak- 
ing the application. In younger children the procedure 
is often one of a good deal of difficulty, and two persons 
are required to accomplish it satisfactorily. The helper 
holds the child facing a bright light, and wrapped in a 
shawl which keeps its arms and hands close to its sides. 
The nurse now takes her position opposite it, with a tea- 
spoon in the left hand and a brush already prepared in 
the other. Watching her opportunity, she carefully in- 
serts the handle of the spoon between the teeth and 
gradually works it inward. As it reaches the back of 
the tongue the child gags and at the same time invol- 
untarily opens its mouth widely. This is the moment 
for the rapid yet thorough painting of the throat. 



16 



242 THE CARE OF THE BABY. 

Spraying of the throat is done with an atomizer 
(Fig. 51). When employing this apparatus it is im- 




FiG. 51. — Bulb atomizer. 

portant to see that the tongue is well depressed, as 
otherwise most of the solution lights upon it instead 
of where needed. 

The method of observing pulse, temperature, and res- 
piration has alread}^ Deen considered in Chapter II. 

A few words only can be devoted here to the diet to be 
followed in sickness. As has already been intimated it 
may be accepted as an axiom that every child suddenly 
taken ill is better, for some time at least, without food. 
This is particularly true of infants attacked by severe 
acute vomiting and diarrhoea. There is absolutely noth- 
ing to be gained by putting into a baby's stomach food 
which will simply serve to keep up the irritation present 
there or in the intestines. Certainly all milk should be 
stopped for twenty-four hours, and the baby be fed on 
barley-water (Appendix, 2) or albumen-water (Appendix, 
3). A loss of appetite with a coated tongue occurring 
in a child of any age is not always a sign that a tonic 
or digestant is needed. It is often but a prayer on 
the part of the stomach to be given a period of rest. 
Should a feverish condition last some days, the diet 



THE SICK BAB V. 



243 



should continue to be of the lightest. It is often one of 
the most difficult things imaginable to find out what 
kind of food will best agree with infants suffering from 
chronic indigestion or chronic diarrhoea. A sincere pity 
for the little patients compels me to urge most strongly 
that the mother make no experiments in such a case. 
Immeasurable harm to numberless babies has followed 
just such experimentation. The experienced physician, 
with his best endeavors, often finds the discovery of the 
proper food a herculean task. The various recipes for 
different articles of diet that will be found in the 
Appendix are intended, not to constitute a list from 
which the mother shall select at her own discretion, but 
to be a guide in the preparation of the food which the 
child's physician may direct. 

A well-trained nurse keeps a careful daily record of 
everything which has taken place relative to the child. 
Thus a portion of such a record would perhaps read as 
follows : 

June 23, 1894. 

8a.m. Temperature, 102.6°; pulse, 140; respiration, 35. Took 
6 ounces of milk and 2 ounces of lime-water. Cough 
medicine and pill given. A half teaspoon ful of whiskey. 

10 A. M. Bowels opened, natural in appearance. 

11 A. M. Took only 3 ounces of milk and i ounce of lime-water. 

Medicine and whiskey given. Temperature, 103°. 
12.30 p. M. Very restless and nervous. Temperature, 105°. Has 
coughed a great deal. Sponged with cool water. 

1 p. M. Temperature, 101.2°. Quiet; looks better. 

2 p. M. Has slept for an hour. Temperature, 102° ; pulse, 132 ; 

respiration, 34. Cough medicine and pill given. Half 
teaspoonful of whiskey and 4 ounces of beef tea. 

Such a record as this is of the greatest assistance to the 
doctor, and tells him of the progress of the case better 
than any answers to questions could possibly do. 



244 



THE CARE OF THE BABY. 



A still better and more quickly-read arrangement, kept 
on paper of a suitable size, would be as follows : 





3 





i 
1 




Medicines. 


Food. 


Stimulants. 


Remarks. 


6,23 
94. 


8 a.m. 


102.6 


140 


35 


I teaspoonful 
cough mix- 
ture and I 
pill. 


60Z. milk and 
2 oz. lime- 
water. 


Yz teaspoon- 
ful whis- 
key. 






10 














Bowels opened ; nat- 
ural in appear- 
ance. 




II 


103 






I teaspoonful 
cough mix- 
ture. 


3 oz. milk and 
I oz. lime- 
water. 


Yi teaspoon- 
ful whis- 
key. 






12.30 

P.M. 


105 












Very restless and 
nervous. Coughed 
a great deal. 
Sponged with cool 
water. 




I 


101.2 












Quiet ; looks better. 




2 


102 


132 


34 


I teaspoonful 4 oz. beef tea. 
cough mix- 
ture and I 
pill. 


% teaspoon- 
ful whis- 
key. 


Has slept for an 
hour. 



As a rule, nurses keep the record of the pulse, tem- 
perature, and respiration on a special chart provided for 
the purpose. There are various charts of this sort, of 
different patterns, to be had from medical publishers. 
The author ventures to recommend the "Graphic Clin- 
ical Chart" designed by himself. 



III. The Disorders of Childhood. 

Under this heading may be considered briefly a few of 
the commoner diseases, habits, and accidents of children, 
with such treatment as the mother is justified in using. 
They are classified to some extent as a matter of conve- 
nience, but the divisions are not sharply defined, and 
some disorders which have been placed in one class 
might with equal propriety have been considered in some 



THE SICK BABY. 245 

other. Lack of space has made the descriptions necessa- 
rily concise. 

(l) DISEASES OF THE DIGESTIVE APPARATUS. 

Hare-lip. — A complete cleft through one or both sides 
of the upper lip, exposing the teeth and even extending 
into the nose. It sometimes interferes with sucking, and 
requires a specially-prepared rubber nipple, or makes 
feeding from a spoon necessary. It should be operated 
upon in the early weeks of life. The success of the opera- 
tion is often very remarkable. 

Cleft Palate. — A fissure through the palate, forming 
one cavity of the mouth and nose. It is very often com- 
bined with hare-lip. It not only greatly interferes with 
talking later in life, but in infancy renders nursing im- 
possible by taking away the power of suction. In such 
a case the child must be fed with the mother's milk from 
a spoon or from a feeding-cup with a spout to it, to which 
a rather long nipple with large openings is attached. 
The milk thus flows into the mouth by gravity, without 
the need of sucking. A special apparatus has been de- 
vised, consisting of an ordinary nipple to the upper sur- 
face of which is attached a flap of thin rubber, made to 
act as a false palate and to close the unnatural opening 
during nursing. Operation is better deferred until the 
child is two or more years old. 

Tongue-tie. — In this condition the little membrane on 
the under surface of the tongue is too tight or is attached 
too far forward and holds the tongue down. It is much 
more uncommon than is ordinarily supposed. If the 
child can suck well and can protrude its tongue at all, 



246 THE CARE OF THE BABY. 

there is no tongue-tie of any account. The operation for 
the affection is simple and painless. 

Inflammation of the Mouth. — ^catarrhal inflamma- 
tion may occur during fever, or from indigestion or lack 
of cleanliness, or sometimes during dentition. The 
mouth is hot and tender, and nursing is painful, the 
nipple being dropped with a cry. The lining of the 
gums, cheeks, and palate is much reddened, and is either 
dryer than natural or very moist from a profuse secretion 
of saliva. 

In aphthous inflammation little shallow ulcers (aphthcE) 
form over the tongue, palate, and inside lining of the 
lips and cheeks. 

The treatment for either of these conditions consists 
in the administration of a mild purgative, such as castor 
oil or magnesia, and the frequent application of a mouth- 
wash (Appendix, 79). 

There is a much more extensive and serious ulcerous 
inflammation, and another still worse, the gangrenous 
form, which must at once be referred to a physician; as, 
indeed, the simpler forms must be if they do not heal 
immediately. 

Thrush. — A disease of the mouth far commonest in 
bottle-fed or sickly children in the early weeks of life. 
Small whitish patches, sometimes crowded thickly to- 
gether, form over the lining of the mouth, and especially 
on the tongue. They greatly resemble curdled milk, but 
differ in that they can be removed only by the use of con- 
siderable force. A lack of perfect cleanliness about the 
mouth and the bottles and rubber nipples, and the use 
of bottles with long rubber tubes, are active factors in 
producing the disease. It is very commonly associated 



THE SICK BAB V. 247 

with some disturbance of digestion, and it is distinctly 
contagious. The symptoms are an indisposition to nurse 
on account of the pain produced, often combined with 
colic, and some diarrhoea and vomiting. 

Treatment consists in the greatest cleanliness in every- 
thing about the food. The patches must be rubbed away 
as gently as possible every two or three hours with the 
finger covered with a soft moist cloth, and the mouth 
then sprayed with a solution of boric acid (Appendix, 
75); or a small portion of borax and glycerin (x\ppendix, 
79) may be applied with a camel's-hair brush. As the 
disease is sometimes fatal in delicate children, the advice 
of a physician should be obtained. 

Disordered Dentition. — It has already been stated that 
the cutting of the teeth is not, as a rule, responsible for 
any of the ailments so commonly attributed to the pro- 
cess, and that redness of and irritation of the gums are 
not necessary parts of it. It is, however, true that some 
babies are peculiarly susceptible to even slight disturb- 
ances in the mouth, and that we occasionally find attend- 
ing the eruption of the teeth various symptoms which can 
be accounted for in no other way. At times a certain 
amount of catarrhal inflammation of the gums is present, 
shown by increased heat with some redness and by a dis- 
position to bite vigorously upon anything placed in the 
mouth. 

Slight diarrhoea, loss of appetite, feverishness, bron- 
chitis, some eruption of the skin, and, especially, great 
restlessness, irritability, or other nervous symptoms, may 
appear shortly before a tooth is cut, and disappear with 
astonishing rapidity as soon as it is through the gum. 
Remarkable improvement will sometimes follow within 
a few hours the lancing of the gum over an approaching 



^48 THE CARE 01^ THE BABY. 

tooth. Nevertheless, it is only rarely that lancing is 
really necessary. The important point is that disordered 
dentition is the exception and not the rule, and that the 
mother must never assume that it is teething which 
makes her baby ill, or try to treat this symptom or let 
it go as a matter of no consequence. 

If the baby enjoys biting at a soft-rubber ring or hav- 
ing its gums gently rubbed with the finger, there is no 
objection to this; but no attempt should ever be made to 
" rub the tooth through " with the finger-nail or a thim- 
ble or other hard substance, as this is often the cause of 
inflammation of the gums. 

Dentition may be much delayed, or the teeth may 
come in irregularly or decay very rapidly. Early decay 
of the teeth or the completion of the first year without a 
tooth makes the existence of rickets seem very probable. 
It occasionally happens that certain of the first or second 
teeth are never cut. 

Gum-boil. — This consists of an abscess at the root of 
a diseased tooth, lasting several days and then usually 
bursting. Painting the gum with tincture of iodine or 
applying one of the little toothache plasters to be bought 
in the drug-stores may prevent the abscess from forming. 
Holding warm water in the mouth or the application of 
a warm-water bag to the cheek relieves the pain. Lan- 
cing the abscess is the quickest cure. 

Sore Throat. — Infants with sore throat avoid much 
nursing and swallow with a gulp and a cry. Older chil- 
dren will frequently complain of the throat, but in many 
cases they make no complaint even though it is much 
inflamed. Fever is generally present, and the speech 
often is a little thick. The throat may be red without 



THE SICK BABY. M9 

swelling of the tonsils, or the tonsils also may be red 
and swollen, and perhaps may exhibit one or more white 
points. It is needless at once to become greatly alarmed 
over these latter. They are common and usually mean 
nothing, but as they sometimes indicate beginning diph- 
theria, the child should be isolated at once and a phy- 
sician be sent for. (See Diphtheria.) 

A child with sore throat should be confined to bed, 
given a laxative, and allowed to suck pieces of ice fre- 
quently and to use an astringent gargle (Appendix, 8i). 
If there is much fever, a simple fever mixture (Appen- 
dix, 103) may be administered until the physician arrives. 
He may find it best to give other remedies or to order 
the throat to be painted internally. The danger of per- 
manent deafness following repeated attacks of sore throat 
must never be forgotten. 

Chronic Enlargement of the Tonsils. — A common 
affection in children, beginning in early infancy. The 
tonsils are pale without sign of inflammation, and some- 
times are so large that they almost touch. Associated 
with this enlargement is usually an overgrowth of certain 
tissue resembling the tonsils, situated out of sight high 
up in the throat at the back of the nose, and it is this 
overgrowth that causes the chief hinderance to breath- 
ing. In some cases the child constantly breathes with 
its mouth open, and often snores badly at night. Its 
speech is thick, affections of the ears are frequent, and 
the voice has a heavy, stopped-up sound, much like that 
of a person with a bad cold in the head. Treatment is 
important, for the constant difficulty in getting sufficient 
air is apt to produce impairment of development and of 
the general health, and even to make the child chicken- 
breasted. Permanent deafness may also result. 



250 THE CARE OF THE BABY. 

Chronic Indigestion. — A condition marked by capri- 
ciousness of or great loss of appetite, coated and often 
*' worm-eaten " tongue, flushing of the face with or with- 
out fever, pain and swelling of the abdomen, restlessness 
at night, slight headache, and often constipation alter- 
nating with slight diarrhoea. Mucus is very apt to 
appear in the passages, whether these are loose or 
hard. The disease is frequently seen in later childhood, 
and is a very obstinate one. In the line of treatment 
diet is of prime importance. All fats and sweets must 
be avoided, and the amount of starchy food be reduced 
very much. Milk, lean meats, poultry, eggs, and green 
vegetables constitute the principal articles of diet. 
Medicines are usually required. 

Vomiting. — The fact that an over-fed baby will regur- 
gitate the excess of milk which it has taken has already 
been alluded to (p. 113). There is a difference between 
regurgitation and true vomiting. The latter is accom- 
panied by coldness and moisture of the skin, indicating 
nausea. The vomitino^ mav be a sino^le effort and mav 
bring relief, or it may be repeated again and again until 
the patient's state is alarming. It does not always in- 
dicate a disordered stomach, for it frequently ushers in 
some acute disease, such as pneumonia or scarlet fever, 
and it is repeated and very obstinate in inflammation of 
the brain. The importance is manifest of having a phy- 
sician determine the cause in serious cases. The chief 
treatment consists in the immediate and absolute stopping 
of all nourishment. No food should be given for six or 
more hours, and after that onh^ small amounts of barley- 
water or albumen- water (Appendix, 2, 3). Complete rest 
is essential, and trotting on the knee, raising suddenly, or 
other quick movements must be avoided. A spice plaster 



»v« 



Plate II. 




size.) 



Roundworm. (Drawn from life ; one-half natural size.) 2. Thread-worms. (Natural 
3. Small portions from different parts in the length of a tape-worm. (Drawn from life ; 



natural size.) 



THE SICK BABY. 25 I 

or mustard plaster (Appendix, 64, 65) may be placed over 
the position of the stomach, just below the ribs in front, 
slightly to the left side. Soda-mint (Appendix, 100) may 
be given, or to older children soda-mint and tincture of 
ginger. The swallowing of pieces of ice (not allowing 
them to dissolve in the mouth) is often useful. After 
the attack is over a laxative, such as magnesia, may be 
administered, for the purpose of carrying out of the 
intestines any irritating substances which may have 
entered them. 

Diarrhoeal Diseases. — These are oftenest caused by 
improper food, by taking cold, or by exposure to the 
sun or to heat. They are exceedingly common in bottle- 
fed babies in summer-time, as a result of changes pro- 
duced in the milk by the high temperature. The num- 
ber of passages varies from four or six up to thirty, forty, 
or more in twenty-four hours. Their character, too, is 
changed from the normal. They may be greenish, yel- 
lowish-green, whitish from the presence of undigested 
milk, clay-colored from absence of bile, black, brown, or 
colorless; semi-liquid or very watery; odorless or ex- 
cessively offensive; small in size or so large that we 
wonder how a child's bowel could have held so much. 
Mucus and blood may be present. 

In simple diarrhoea^ which is very common in summer, 
the passages exhibit some one of the colors mentioned, 
there is little if any fever, and vomiting may or may not 
occur. 

In cholera infanttnn the passages are very numerous, 
are entirely watery and colorless, and there is constant, 
exhausting vomiting and high fever, followed at last by 
great coldness. It is a comparatively rare disease. 

In inflammation of the intestine (inflammatory diar- 
rhoea), on the other hand, the movements are usually 



252 THE CARE OF THE BABY. 

small, liquid, exhibit color of some sort, and contain 
mucus. Moderate fever is present, and vomiting is not 
a prominent symptom. Many of the cases of severe 
summer diarrhoea are of this nature. 

In dysentery — which is only another name for a severe 
form of inflammatory diarrhoea — the passages are small 
and very frequent, are composed largely of mucus, often 
contain a considerable amount of blood, and are accom- 
panied by much straining. • 

An infant ' ' falls away ' ' with astonishing rapidity in 
severe diarrhceal disorders, and in twenty-four to forty- 
eight hours may become shrivelled, wrinkled, and cold. 
The disease is, as a rule, not so rapid or so serious after 
infancy is past, but even then it is very weakening; con- 
sequently no case should ever be allowed to run on with- 
out treatment. A mother, if she cannot conveniently 
do otherwise, may treat slight attacks herself for not 
longer than twenty-four hours, but after this must delay 
no longer in calling in a physician. She should be 
careful to save the passages to show to him. 

The first essential of treatment is to stop all food, since 
it only adds fuel to the fire. A baby if hungry may have 
a little barley-water (Appendix, 2). If very hot it may 
be bathed with cool water, or if cold may have a mustard 
bath. Absolute rest in bed is very desirable. In the 
beginning of the attack a dose of castor oil may be 
given to empty the bowel of anything irritating it. Af- 
ter this I or 2 teaspoonfuls of a chalk-and-bismuth mix- 
ture (Appendix, 102) may be given every couple of hours. 
Bismuth colors the passages black, and no alarm need be 
felt at the presence of this color. The mother should 
never give paregoric, laudanum, or other preparation of 
opium to a child suffering from diarrhoea or any other 
disease. It is an invaluable but a danorerous medicine. 



THE SICK BABY. 253 

Some healthy-looking but over-fed babies, instead of 
regurgitating, constantly void undigested milk in the 
stools and have too frequent passages. The amount of 
food should be reduced or its character altered. Insuf- 
ficient clothing is a cause of repeated attacks of diar- 
rhoea. A careful covering of the abdomen, arms, and 
legs with close-fitting garments of a nature suitable to 
the season is the best prevention. 

Constipation, — A very frequent disease in children, 
and especially in infants. Those fed on the bottle are 
most disposed to it. The passages may be too infrequent 
or too hard, and generally are both. In treating the 
affection the cause of the difficulty should be sought and 
removed, and laxative drugs be kept as a last resource. 
As an increase of the fat in the food is often needed, a 
larger proportion of cream can be added to the bottle, or, 
in the case of breast-fed babies, be fed from a spoon. A 
teaspoonful or less of olive oil given once a day, or of 
drug-store '* syrup" two or three times a day, is harmless 
and often effectual. The employment of oatmeal-water 
(Appendix, 5) instead of plain water in preparing the 
bottle, or of brown sugar or a syrupy malt extract for 
sweetening it, may have the desired laxative effect. 
When this does not answer, a small quantity of the oat- 
meal itself or of other starchy food may be added instead 
of oatmeal-water, but this should be done only by a phy- 
sician's advice. In children over one year of age a little 
stewed fruit or a baked apple may be tried carefully. 
Strained stewed-prune juice is often excellent. The juice 
of an orange is frequently very serviceable, and a little 
may sometimes be given with advantage even to a younger 
baby. In still older children the diet should contain plenty 
of fluid and of foods that are somewhat laxative. 



254 THE CARE OF THE BABY. 

The very early cultivation of a habit of regularity helps 
to prevent constipation. At a certain fixed hour, best 
after one of the principal meals, generally breakfast, the 
baby as soon as old enough may be supported on its 
nursery chair and kept there for five minutes at least, 
but never permitted to strain. A daily cool bath fol- 
lowed by brisk friction is of decided benefit. Daily mas- 
sage of the abdomen is an excellent remedy, practised 
just before the hour at which an evacuation is desired. 
The palm of the hand should be applied with gentle 
pressure just above the right groin, and be carried in a 
horseshoe-shaped curve up to the edge of the ribs, across 
to the left side, and down toward the left groin, thus fol- 
lowing the course of the large intestine and propelling its 
contents toward the opening. The hand should be 
warm, a little sweet oil or vaseline should be used, and 
the massage should last about ten minutes. 

The treatment detailed is intended for habitual consti- 
pation. For the immediate unloading of the bowel one 
of the simplest and least harmful methods is the giving 
of one or more enemata of warm water containing salt in 
the proportion of a teaspoonful to a pint. Soapy water 
may be used instead if something stronger is needed. 
The amount to be injected varies with the age. For 
young babies one or two ounces is sufiicient, and for those 
of two years two or three times this amount. Either the 
hard-rubber syringe or the infant's syringe may be used 
(pp. 240, 241). A useful injection consists of half a tea- 
spoonful of glycerin with an equal quantity of water, or, 
if this does not answer, of glycerin in full strength. 
This is best given from a small hard-rubber syringe hold- 
ing not more than half an ounce. The opening in the 
nozzle should be larger than ordinar>^, as the glycerin 
does not flow readily. If the mass in the bowel is large 



THE SICK BABY. 



255 



and very hard, an injection of warm sweet oil, retained 
some hours if possible, is better than anything else. It 
should be followed by an enema of soapy water. In some 
cases it is necessary to insert the finger or a small spoon- 
handle into the bowel and break up the masses carefully. 

Glycerin suppositories (glycerin and soap) of a size for 
children are often excellent for emptying the bowel. 
Gluten suppositories are also serviceable in many in- 
stances. A more economical plan is to employ little 
home-made suppositories of Castile soap, or, in place of 
these, a soap stick, which also can be made at home, and 
which has the advantage of lasting for repeated usings. 
It consists of a smooth, conical stick of firm Castile soap 
two or more inches long, half an inch thick at the base, 
and tapering toward the other end to the thinness of 
about one-quarter of an inch (Fig. 52). It should be 
greased with vaseline before using it, in- 
serted part way into the bowel, and held 
there until a tendency to an evacuation 
shows itself. 

If none of the methods described are 
effectual, laxative drugs must be employed. 
Their use, however, ought to be deferred as 
long as possible, and is much better left to 
a physician. Probably the best and least 
harmful of drugs is cascara in some form. 
There is made a cascara cordial which has 
a pleasant taste and is very effectual. 
Another very useful preparation is the syrup of senna, 
which is easily taken by children, as its taste is agree- 
able. Ivittle sugar-coated pills each containing -^ grain 
or less of aloin are sometimes of service, one being given 
daily to a child of two years. A small quantity of 
manna, about 5 grains, can be given to a baby of six 



Fig. 52. — Soap 
stick. 



256 THE CARE OF THE BABY. 

months once a day or oftener, dissolved in the milk, as 
its taste is sweet, or 10 grains of phosphate of soda may 
be used in a similar manner. Magnesia or spiced syrup 
of rhubarb answers very well, but only for occasional use. 

Colic. — Severe pain in the abdomen, usually due to 
distention by gas. It is one of the commonest ailments 
of infancy, and frequently appears in those perfectly well 
in other respects. It may occur either only occasionally 
or many times every day. The symptoms consist of 
sudden and violent crying — which may continue until 
the child is bluish in the face and often exhausted and 
cold — a swollen and hard abdomen, and doubling up and 
straightening of the legs, arms, and trunk. These symp- 
toms last a variable time and then suddenly cease, per- 
haps preceded by the passage of wind by the mouth or 
bowel. Chilling of the skin and indigestion are the 
commonest causes, the latter usually depending on too 
frequent or too abundant feeding. To prevent repeated 
attacks the stomach should be allowed to rest by dimin- 
ishing the amount of nourishment and increasing the 
length of time between feedings. If the baby is bottle- 
fed, it may be necessary to change the character of the 
food in some way, but this should be the duty of the 
physician. The child must be warmly clothed, since any 
chilling of the surface may cause pain, no matter how 
good the digestion may be. The feet and legs especially 
should be kept warm by thick loose stockings and by 
daily friction with a mixture of i part of turpentine 
and 3 parts of sweet oil. An abdominal binder may 
be worn if one is not already in use. 

During an attack the baby must never be fed. The 
warm milk, it is true, often stops the crying for the mo- 
ment, but it is sure to increase the indigestion and to 



THE SICK BABY. 



257 



bring the pain back as bad as, or worse than, ever. 
Rubbing the abdomen for several minutes, or the mere 
change of the child's position, as by lifting it over the 
shoulder, will sometimes cause the gas to escape and the 
colic to cease. A spice plaster (Appendix, 64) is often 
very useful. Sometimes an injection of two or more 
ounces of warm water will relieve the attack. Generally, 
some medicine given internally is necessary. Pepper- 
mint-water or cinnamon-water, diluted and sweetened 
and given after each nursing, may keep the pain from 
coming on; while during an attack one of the simplest 
and most effectual remedies is soda-mint (Appendix, 100) 
mixed with an equal quantity of hot water and given 
every half hour or hour for a time. If the baby seems 
exhausted and cold as a result of the pain, it should 
be given a few^ drops of brandy in a teaspoonful of hot 
sweetened water and be placed at once in a hot bath, 
and after that should be kept very warm and have a 
mustard plaster (Appendix, 65) applied over the abdo- 
men. The doctor should be summoned at once. Con- 
stantly-recurring colic, not relieved or prevented by the 
means described, is beyond the ability of the mother to 
treat. 

Congenital Closure of the Bowel. — Complete ob- 
struction, oftenest not far within the opening of the 
bowel, or the entire absence of any opening. Failure on 
the part of the baby to empty its bowels for one or two 
days after birth renders one suspicious of the presence of 
this condition. Unless some operation is performed, 
death is inevitable in the course of a few days. 

Prolapse of the Bowel. — A protrusion of more or less 
of the bowel through the external opening. It is usually 

17 



258 THE CARE OF THE BABY. 

the result of diarrhoea or of the straining of constipation, 
and generally occurs in debilitated children. In the 
mildest and fortunately the most frequent cases only the 
lining of the bowel is pushed out for about half an 
inch, forming a dark, purplish-red, puckered ring out- 
side of the opening. This can be easily pushed back, 
or it goes back of itself after a little time. The protru- 
sion may take place every time the bowels are opened 
with the slightest straining effort. In the more serious 
cases a protrusion of five or six or more inches of intes- 
tine may take place at any movement of the bowels, or 
even when the child is walking or standing. The pro- 
lapsed bowel gives at first discomfort, and soon actual 
pain if not replaced. After the protrusion has occurred 
a few times it is apt to happen repeatedly. 

The first treatment is to replace the prolapse. The 
child should be laid upon its back or stomach and the 
protruding bowel be gently pushed back with the fingers, 
previously well greased with vaseline. To prevent the 
recurrence the passages must be kept soft and all strain- 
ing be avoided. • Cold bathing of the parts is useful. 
While the bowels are being moved some support must be 
given by pressing the buttocks together or by placing 
the child upon its back and receiving the passages in a 
diaper. A board with a small hole in it three or four 
inches in diameter, placed over the chamber, gives great 
support and tends to prevent prolapse. In cases which 
do not readily yield to this treatment astringent injec- 
tions or suppositories will be prescribed by the physician 
in charge. Very bad cases need operation. 

Rupture; Hernia. — A protrusion of a portion of the 
bowel through some weak spot in the muscles of the 
abdominal walls, forming under the skin a soft, round 



THE SICK BABY. 259 

swelling which grows larger when the child cries, 
often disappears when it lies down, and can easily be 
pushed back into the abdomen. It is a common affec- 
tion in infants, may even be present at birth, and is most 
often seen at the navel, and next in the groin. Hernia 
is always dangerous if neglected, and should be treated 
at once. The physician in charge will probably pre- 
scribe a truss, which must be worn the entire time. If 
for any reason the truss is taken off for a moment, the 
bowel must be kept in by the hand. Recovery nearly 
always follows if treatment is begun early. Should a 
baby with rupture begin to cry persistently, to suffer 
from constipation and obstinate vomiting, and to appear 
very ill, a physician must be called immediately, for it is 
possible that the bowel has been constricted at the open- 
ing through the tissues and has become inflamed, and 
the condition is then very serious. 

Worms. — There are three principal species of worms 
which may be found in children: (i) the thread-worm; 
(2) the round worm ; (3) the tape- worm. The first and 
second varieties are much the commonest. 

Worms produce only indefinite symptoms or none at 
all. They may, it is true, cause itching at the opening 
of the bowel, picking at the nose, variable appetite and 
other evidences of disordered digestion, restlessness at 
night, grinding the teeth, and perhaps even convulsions, 
but many other disturbances of the digestive canal can 
produce these symptoms equally well. 

(i) Thread-worms or seat-worms strongly resemble 
little pieces of white cotton thread from }{ to j4 inch 
long (PL 11. , Fig. 2). They occupy the lower part of the 
bowel, and coat the passages in great numbers. This 
species is the one particularly liable to cause severe itch- 



26o THE CARE OF THE BABY. 

ing of the opening of the bowel at night. Treatment 
consists in great cleanliness and the injection every other 
night for a week or two of as much of an infusion of 
quassia (Appendix, 88) as the child can hold comfortably. 
If this does not answer, medical advice will be needed. 

(2) Round worms are reddish- white in color and resem- 
ble common earth-worms in shape, but are thicker and 
from four to twelve inches long (PI. II., Fig. i). They 
inhabit the small intestine, but often wander into the 
large intestine and are evacuated, and sometimes even 
enter the stomach and are vomited. They are present in 
the bowels in great numbers. Although evidences of 
indigestion may be present, the only characteristic symp- 
tom is the discovery of the worm in the passages. No 
"worm medicines" should ever be given except by the 
family doctor, for they are not safe in the hands of 
others. 

(3) Tape-worm is occasionally seen in children. Often 
not even the ordinary evidences of digestive disturbance 
are produced by it, and the only way of recognizing that 
there is a worm is the discovery of portions of it in the 
passages (PI. II. , Fig. 3). The parasite is composed of 
a great number of segments joined together, making a 
total length of perhaps many feet. The segments are 
smaller and smaller as they approach the "neck" and 
the "head." The neck is no thicker than a thread, and 
the head is only about as large as an ordinary pin-head. 
The treatment of the disease is beyond the skill of the 
mother. It is essential to remove the head in order to 
prevent a new worm from forming. To be sure that this 
has been accomplished the passages should be received 
in a vessel of water and then be shaken d.bout gently and 
without pulling the worm until the feces are entirely 
separated. The water may then be poured oflf carefully 



THE SICK BABY. 26 1 

and fresh added until quite clear, when the worm may 
be examined. The worm should never be pulled upon 
while it is being passed, lest the head be broken oflf 
in the bowel. 

Jaundice. — A very common affection in the first week 
of life, characterized by yellowness of the skin, the 
whites of the eyes, and the lining of the mouth, and 
by highly-colored urine which stains the diapers yellow. 
It is commonly unattended by other symptoms, and dis- 
appears in a week or ten days. Rarely it is an evidence 
of some serious or fatal disease. Very young babies are 
liable to acquire a yellowish tint of the skin which is not 
jaundice, since the whites of the eyes are not affected. 

Older children may develop jaundice associated with 
symptoms of indigestion. Treatment for infants is often 
not needed, while older children may have a light diet, 
as of beef tea or milk foods, and be given magnesia or 
some laxative mineral water. It is much better, how- 
ever, to call in the family physician. 

(2) DISEASES OF THE ORGANS OF RESPIRATION. 

Cold in the Head ; Coryza. — A disorder to which 
children are particularly liable on account of the greater 
sensitiveness of their skin. To avoid it draughts must 
be carefully shunned, particularly upon the nearly-bald 
head of a baby, clothing must be sufficiently warm, and 
the general health must be made robust by an outdoor 
life and the avoidance of over-heated and ill-ventilated 
rooms. The symptoms consist in watering eyes, sneez- 
ing, running nose, and a nasal tone of the voice. The 
disease is troublesome in infancy, for the obstruction to 
the breathing renders nursing difficult. One of the great 
dangers dependent on coryza is inflammation of the ears, 



262 THE CARE OF THE BABY. 

or, in case colds are of frequent occurrence, permanent 
deafness. 

Treatment consists in giving the child a warm bath in 
a warm room, drying it carefully and rapidly, and keep- 
ing it in a temperature which is very equable and rather 
higher than usual. It is better, indeed, to put the child 
to bed. The diet should be lighter than usual. A laxa- 
tive, preferably castor oil, should be given, and a fever 
mixture (Appendix, 103) if needed. It is often useful 
to apply vaseline within the nose with a camel' s-hair 
pencil, and also to rub it upon the bridge. 

Spasmodic Croup. — This disease, although very alarm- 
ing, is fortunately not often dangerous. It is generally the 
result of exposure to cold, but is sometimes due to indi- 
gestion or to irritation of the throat. Some children are 
very liable to suifer from repeated attacks, while others 
never do, however severely they may take cold. Often 
there is an evident family predisposition. The symptoms 
may or may not begin with hoarseness during the day, 
and toward night the peculiar sharp, barking, metallic, 
' ' croupy ' ' cough. After the child has been asleep for a few 
hours it awakes suddenly, sits upright and grasps at any- 
thing it can reach, and is scarcely able to get its breath. 
The croupy cough is now loud and ver}' characteristic, the 
inspiration of air noisy, the voice only a hoarse whisper, 
and the face bluish and perspiring. The worst of the 
condition lasts only a few minutes, but a tendency to 
croupy cough and oppressed breathing may persist for 
perhaps half an hour or longer, after which the child 
drops asleep, and usually rests quietly for the remainder 
of the night. Another attack is very apt to occur upon 
each of several succeeding nights. 

The disease is commonest in the third year of life, and 



THE SICK BABY. 263 

then steadily decreases in frequency. It is seen only 
occasionally after the age of six years. 

Treatment is primarily preventive. Croupy children 
should be guarded with especial care against exposure to 
wind and damp. On the slightest sign of croupiness in 
the afternoon the mother should administer some medi- 
cine prescribed by the physician; or, in case she has no 
such preparation, she can use that given in the Appendix 
(104). This is not one of the strongest, but is one which 
she can safely give without medical advice. 

In the treatment of the attack a warm mustard bath 
and an emetic (Appendix, 106) should be given. Moist- 
ening the air with the steam atomizer or the croup kettle 
(p. 214) is of great service. There is absolutely no value 
in amber necklaces and such other relics of barbaric 
superstition, except the sedative action upon the mind 
of the mother. Instances of apparent cure by them are 
merely coincidences. 

Membranous Croup. — See Diphtheria. 

Bronchitis. — An inflammation of the bronchial tubes 
accompanied by cough. It is a very common affection in 
children, and results from taking cold. It is usually pre- 
ceded by a cold in the head. Any hoarseness present is 
due to laryngitis. The cough is frequent, at first dry 
and tight, but later becoming loose and rattling as the 
inflammation diminishes. Often some wheezing or rat- 
tling can be heard with respiration. The child does not 
seem very sick unless the bronchitis is unusually severe; 
has but slight fever, and breathes but little, if any, more 
rapidly than natural. It may raise a good deal of mucus, 
but, before the age of six or seven years, nearly always 
swallows it instead of spitting it out. The only treatment 



264 T^HE CARE OF THE BABY. 

the mother may venture on is the general method advised 
for cold in the head, combined with a thorough rubbing 
of the chest, both in front and behind, twice a day with 
oil of amber, diluted with equal parts of sweet oil if the 
patient is less than a year old. A physician should be 
called in at once, as in infancy and early childhood the 
disease may easily pass into pneumonia. 

Pneumonia. — The terms congestion of the lungs^ pneu- 
monia^ capillary broitchitis^ and inflamjnation of the lungs 
are to all intents and purposes identical in meaning. 
The disease may come on suddenly, perhaps even with a 
convulsion and without previous warning, or it may de- 
velop from a bronchitis already present. There are high 
fever, flushed cheeks, a frequent, painful, and very short 
cough, and rapid catching breathing, with a moving in 
and out of the edges of the nose, and, in bad cases, of 
the pit of the stomach, the spaces between the ribs, and 
the muscles of the neck. The child is restless and toss- 
ing, or, if very sick, sometimes lies quiet with its cheeks 
and lips pale and bluish and its breathing very rapid and 
shallow. 

The disease is always serious, and requires the com- 
bined skill and attention of the physician, nurse, and 
mother. In addition to what was said in the general re- 
marks on disease and on nursing earlier in this chapter, 
it may be stated here, first, that the labored breathing 
shows the need of plenty of fresh air, although without 
draughts; second, that the child may be allowed to assume 
any position it pleases, and that a change of position may 
give great relief; third, that in any case where blueness, 
pallor, and failure of the powers are coming on rapidly, 
a hot bath may be administered while the doctor is being 
sent for, and may save the baby's life (see p. 366). 



THE SICK BABY. 265 

(3) DISEASES OF THE BRAIN AND NERVOUS SYSTEM 
AND OF THE SPECIAL SENSES. 

Convulsions, Spasms. — One of the most common 
and dangerous diseases of infancy and early childhood, 
demanding knowledge, presence of mind, and decision 
on the part of the mother. Among the various causes are 
the onset of some severe illness — such as pneumonia or 
scarlet fever, — indigestion, constipation, intestinal worms, 
high fever from whatever source, disordered dentition, 
diseases of the brain, very hot weather, fright, severe 
pain, rickets, whooping-cough, etc. The frequency of 
convulsions is much the greatest in infancy, and rapidly 
diminishes after the first year. In the mildest attacks, 
often called "inward spasms," there may be only a 
tendency to squint and to bend the thumbs into the 
palms, with slight twitching of the mouth or eyelids, 
and perhaps of the head or limbs. These symptoms may 
pass away in a moment or may usher in a genuine 
attack. 

In a typically severe convulsion the child often makes 
a choking sound, ceases to breathe for a moment, and 
becomes unconscious, stiff, and somewhat arched back- 
ward. The eyes are staring, rolling, or squinted, the 
hands clenched, and the mouth firmly shut. In a few 
seconds the face becomes bluish from lack of air in the 
lungs, and then the "working" begins. In this stage 
the breathing is irregular and noisy; the arms, legs, and 
trunk are jerked about in all directions, but principally 
with an alternate bending and straightening movement; 
the eyes are rolled; there is frothing at the mouth, and 
the teeth, if there are any, are ground together and may 
bite the tongue. In a few moments the movements grow 
less violent and then cease, and the child begins to cry 



266 THE CARE OF THE BABY. 

or goes into a heavy sleep with its body rather stifFer 
than usual. Sometimes before consciousness is entirely 
regained another spasm occurs, and so the child may go 
on from fit to fit until it dies. The whole attack lasts 
from one or two minutes to hours. 

Treatment must be very prompt. The child should 
at once have a bath of ioo° F. which should cover it 
to its neck, while cold cloths, frequently renewed, are 
kept on its head. It must be left in the water for ten 
minutes, and then be wrapped in a blanket without dry- 
ing. Since the attack may be due to irritating food in 
the stomach, the child should be made to vomit by giv- 
ing it a teaspoonful of syrup of ipecacuanha or other 
emetic (Appendix, io6) just as soon as it can be made to 
swallow. If the fit still continues and the doctor has not 
come, the bowel should be washed out with a large injec- 
tion of warm water, and this be followed by one suitable 
to quiet the nervous system (Appendix, 87), the latter 
injection being held in by pressure of the thumb over the 
opening of the bowel. Fortunately, the hot bath and 
the emetic answer every purpose in most cases, and 
relieve the attack in a few minutes. 

In very severe cases which have resisted other treat- 
ment and where no physician can be obtained, the child 
may be made to inhale a small quantity of ether poured 
upon a towel and held close to the nose. This should be 
kept up only until relaxation of the body and cessation 
of the convulsive movements occur. It must be borne 
in mind that ether in unskilled hands is dangerous. It 
should be used only as a last resort, and because not to 
use it is the greater evil. 

The conviclsions of epilepsy are identical in appearance 
with the ordinary spasms described. They may begin in 
early infancy, and in such cases can be distinguished 



THE SICK BAB V. 26/ 

only by the persistent recurrence of the fits as the child 
grows older. No special treatment is needed during the 
epileptic convulsion, other than placing the child in a 
comfortable position, guarding it from injuring itself and 
loosening the clothing about the neck. No effort should 
be made to straighten the arms, bend out the thumbs, 
hold down the legs, and the like. 

Night-terrors. — In this disease a child of from two to 
six years or older, apparently in perfect health, starts 
suddenly from sleep, screaming and cold with fright, 
stands in bed or even runs through the room, does not 
seem thoroughly conscious, fails to recognize its mother, 
and cannot be pacified. Night-terrors differ from an 
ordinary nightmare in the confusion and fright which 
persist after waking, and in the child's inability to tell 
afterward what frightened it. As a rule, the attacks, of 
which there is usually but one in the course of the night, 
come on after one or two hours' sleep, and last but a 
few minutes. They may occur every night or only at 
irregular intervals, and in rare cases they take place even 
while the child is awake during the day. The principal 
causes are some disturbance of digestion and the exist- 
ence of a highly sensitive nervous system. Treatment 
consists in careful diet if there is indigestion, the avoid- 
ance of excitement, a healthy outdoor life, and especially 
the giving of a very light evening meal. If this does 
not cure and the attacks are frequent, medical advice 
should be obtained, as l)ad cases may possibly run into 
epilepsy. 

Sleeplessness; Insomnia. — This arises from a great 
many difi'erent sources, and the treatment, of course, 
varies accordingly. Among the causes may be men- 



268 THE CARE OF THE BABY. 

tioned colic or pain of any other nature; constipation; 
indigestion; too much sleep during the day; too early 
going to bed; too exciting play just before bedtime; 
hunger resulting from too long an interval between nurs- 
ing and putting to rCvSt; too hearty a supper in the case 
of older children; not enough fresh air during the day; 
imperfect ventilation and over-heating of the bed-room; 
hot bed-covering at night; cold feet; a bright light in the 
room, and the sound of voices penetrating into it. The 
remedies for these causes are self-evident. A baby nursed 
too frequently during the day may show the force of 
habit by desiring to be fed often during the night, 
although not actually hungry. When a baby begins to 
fret as though sleepy, and yet will not sleep, it is fair to 
presume that it has been over-fatigued. It is ' ' too tired 
to sleep." Prevention is the only cure for this. In 
many cases, especially in nervous subjects, there seems 
to be no cause whatever for insomnia except an individ- 
ual peculiarity, and the child may lie in bed entirely 
comfortable, yet equally wakeful. In such cases it is 
often a good plan to give the daily bath at bedtime, mak- 
ing it slightly warmer than usual, in order to obtain its 
sedative action, and simply to sponge in the morning. 
Sometimes putting the child to bed at a rather later hour 
is of service. 

There is a large selection among drugs useful in sleep- 
lessness, and some of them are decidedly harmful under 
certain conditions. The one to be chosen requires very 
careful consideration, and the mother should never give 
any of them except by medical advice. 

Headache. — Pain in the head is of frequent occurrence 
in children, and even in babies. Older children com- 
plain directly of it, but in infants it can be recognized 



THE SICK BABY. 269 

only by a wrinkling of the brows, persistent crying, a 
rolling of the head from side to side, or the moving of 
the hand toward the painful region. The causes of head- 
ache are very numerous, and often difficult to ascertain. 
Among the most common of them are forms of brain 
disease, and especially meningitis, fever from any cause, 
neuralgia, indigestion and constipation, fatigue, im- 
poverishment of the blood, strain of the eyes at school, 
excessive mental work, general debility, and disease of 
the heart or kidneys. To distinguish which is the acting 
cause, and then to determine what treatment is required, 
is usually beyond a mother's power. Rest, the preven- 
tion of noises, bathing the head with cold water or bay 
rum, a mustard plaster at the back of the neck, a mus- 
tard foot-bath, restricted diet, and the administration of 
a laxative may be tried without danger. 

St. Vitus's Dance; Chorea. — A nervous disorder 
chiefly seen in children, characterized by irregular jerk- 
ing movements of the arms and legs, often with grimaces 
and sometimes with decided loss of power. The attack 
frequently begins with what appears to be awkwardness, 
the child dropping its food at the table, and having a 
tendency to walk awkwardly or trip over things. 

The disease may become so severe that the child is 
unable to feed or dress itself, or even to walk. 

The affection often can be traced to a fright or to over- 
work at school or other nervous strain. It also appears 
to be especially liable to develop in rheumatic children. 
Its great danger is that it may be followed by heart dis- 
ease. 

The child should be taken from school, and all sources 
of excitement removed. Sometimes confinement to bed 
is necessary. In all cases medical treatment is required. 




2/0 THE CARE OF THE BABY. 

Paralysis ; Palsy. — A widespread or limited, more or 
less complete loss of power. There are various causes 
and forms of the disease. Sometimes the pressure occur- 
ring naturally during a tedious confinement, or less often 
that occasioned by the use of instruments, injures the 
brain, and both affects the mind and produces a birth- 
palsy as well. Generally the arm and leg of only one 
side are affected, yet both sides are not infrequently in- 
volved. This form of birth-palsy may improve con- 
siderably or may become worse with advancing years. 
Sometimes a paralysis of one side of the face or of one 
arm occurs during birth from direct pressure of instru- 
ments upon a nerve, the brain having nothing to do with 
it. This variety will nearly always recover in a few 
days or weeks. 

There is 2^ paralysis following diphtheria which attacks 
especially the muscles of the throat and eyes, causing 
food to enter the back of the nose and producing squint. 
Occasionally it affects the whole body. Recovery is 
usually complete. 

Paralysis of a somewhat similar nature, due to inflam- 
mation of the nerves not the result of diphtheria, is 
occasionally seen. 

A paralysis due to disease of the spinal cord is frequent 
in children. The commonest form begins suddenly with 
fever, restlessness, sometimes convulsions, more or less 
delirium, and other vague symptoms. No diagnosis is 
possible until in a day or so paralysis of one or more 
extremities develops. Sometimes the onset is even more 
sudden, and a child, well on going to bed, is found para- 
lyzed in the morning. Considerable improvement takes 
place, though slowly, but more or less loss of power 
and wasting of the limbs will probably remain through 
life. 



THE SICK BABY. 2/1 

Another form of spiual paralysis is that occurring in 
curvature of the spine. (See Pott'' s Disease^ p. 281.) 

The greatest perseverance in carrying out the treat- 
ment is necessary in all forms of paralysis. The affected 
parts are frequently cold, and need to be dressed very 
warmly. After the acute stage is over thorough rubbing 
and kneading must be kept up day after day for months 
in the effort to maintain and to increase the strength of 
the muscles. The physician in charge may advise elec- 
tricity for the same purpose. The child should in most 
cases be made to use the paralyzed parts as much as pos- 
sible. The use of crutches and other apparatus must 
not be begun unless absolutely unavoidable, as this is 
the most certain way to render them indispensable 
throughout life. If the doctor finds that the child 
really cannot learn to walk again, he will probably 
advise some sort of brace which, with the help of a 
cane, will give the needed support and render crutches 
superfluous. 

Hydrocephalus; Water on the Brain. — This is an 
enlargement of the head resulting from a great accu- 
mulation of fluid within the skull. The head and the 
fontanelles grow constantly larger, the latter bulge, and 
the bones become thin. The shape is somewhat glob- 
ular, so that the face seems small and the head very 
large, the forehead overhanging the face, and the sides 
of the head extending beyond the ears. In mild cases 
the mind is not affected, but in severer ones the child is 
feeble-minded and has little control over its body. (PI. 
III., Fig. I.) 

Feeble-mindedness; Idiocy. — Idiocy — which differs 
from feeble-mindedness only in degree — is a condition 



2/2 THE CARE OF THE BABY. 

which is often born with the child, although it may 
develop in infancy or childhood as the result of some 
disease or from injury to the brain. A congenitally 
weak-minded baby does not notice as soon as it should. 
It will perhaps not follow a bright light with its eyes, 
nor turn its head toward the source of a noise, long 
after a normal child does both of these acts. As it grows 
older it is very slow in learning to hold up its head, to 
sit up, or to hold objects in its hands. Even by two 
years of age it may make no attempt to walk or to utter 
any distinctly-articulated sound. Its face has a vacant 
expression and it slobbers a great deal. At three or four 
years of age it may have learned a few words or may 
still be unable to speak or to understand at all. 

This description is of a well-marked case. There are 
all grades of the condition, however, down to what may 
be called simply backwardness^ in which the child's 
powers are slow in developing, but finally expand to a 
very satisfactory degree if carefully trained. The mother 
must be able to recognize the mental defect as early as 
possible, with the intent that she may lose no time in 
beginning the training. The success at best is slow, and 
efforts must be unremitting and be uninfluenced by dis- 
couragement. Sometimes it is better to place the child 
in^an institution where its education can be superintended 
by those accustomed to this work. 

Deaf-mutism. — This resembles idiocy so closely for 
the first few months of life that its recognition is dif- 
ficult or impossible. A deaf-mute takes no notice of 
sound because it cannot hear it, while a feeble-minded 
baby hears, but has not the sense to notice it. By the 
age of six months we should be able to decide between 
the two conditions. A deaf baby shows by this time 



THE SICK BABY. 273 

none of the bodily feebleness or lack of development of 
the idiot. It has an intelligent expression, and will play 
with toys and smile at its mother, yet will take no notice 
of such a sound as that of a bell rung behind it. Very 
loud noises may make an impression upon it, either be- 
cause it is not totally deaf or, more often, because it feels 
such vibrations as come, for instance, from the slamming 
of a door. The child's ears should at once be examined 
by an aurist, in order that something may be done, if 
possible, before it is too late. If found incurable, it 
should when older be trained to talk and understand by 
lip-reading, in which so much success has been attained 
in recent years, and which is so superior to the awkward 
deaf-and-dumb alphabet. There are institutions which 
are devoted solely to this instruction, and children often 
learn articulate language so well that they talk audibly 
and understand almost as if they could hear. 

Congenital Blindness. — This cannot at first be dis- 
tinguished from idiocy, which, indeed, not infrequently 
accompanies it. Only time can show the difference. A 
feeble-minded child will eventually learn to fix its eyes 
upon objects unless it is an absolute idiot, in which case 
its mental deficiency will show itself in other ways as 
well. 

Inflammation of the Eyes. — This affection may occur 
at any age. The most dangerous form {ophthalmia of 
the new-born^ ophthalmia neonatorimi) is that which 
develops a few days — usually about three — after birth, 
and which may cause blindness in spite of the most 
careful treatment. To prevent this the eyes should be 
carefully washed after birth, in the manner described in 
Chapter IV. Should the inflammation begin, the lids 

18 



274 THE CARE OF THE BABY. 

stick together after sleep, and pus may be found at the 
corners and on the inner surface of the lower lid. The 
lids soon swell greatly, and their lining and that of the 
eye itself is very red and secretes an abundant thick dis- 
charge. As this is very infectious, the nurse must care- 
fully keep any of it from getting into her own eyes or 
those of the mother or of other children, while at the 
same time the baby's other eye, if sound, must be 
guarded by an antiseptic bandage. A physician must be 
summoned without a moment's delay, since thorough and 
early treatment of a cleansing and disinfecting nature is 
essential. The nurse must see that the eye is kept 
scrupulously clean by very frequent washing, and that 
the lotion ordered really gets inside the lids. To accom- 
plish this the baby should be held on the lap, with the 
head inclined backward and toward the diseased side. 
The lids must then be gently separated and the lotion 
dropped in from an "eye-dropper." This consists of 
an ordinary medicine-dropper, but with the point 
smooth and rounded or bulbous to prevent accident. 
Absorbent cotton wet with the lotion may be used in- 
stead of the dropper. The lower lid is drawn down 
slightly and some of the fluid is squeezed upon it. The 
solution should enter at the corner next the nose. The 
inclination of the head carries it through toward the 
cheek, thus keeping it away from the sound eye. The 
sticking of the lids may be prevented by rubbing their 
edges with a little vaseline. Any cotton or cloths used for 
washing the eye should be burned, and the nurse should 
disinfect her hands after each treatment of the child, and 
before she touches her own eyes (Appendix, 96, 97). 

Older children may suffer from various forms of inflam- 
mation. In some of the severer cases minute blisters or 
ulcers develop upon the front of the eyes, and children 



THE SICK BABY. 275 

cannot be persuaded to open them at all on account of 
the great pain which light produces. As it is difficult 
to distinguish between the serious and the trifling inflam- 
mations, a physician should be consulted promptly. Pre- 
vious to his visit the eyes may be bathed frequently with 
cold water and a little soothing eye-wash dropped into 
them often (Appendix, 80). No poultice or bandage, or 
any of the numerous eye-washes sold in the shops, should 
ever be used without a physician's advice. 

Sometimes the edges of the lids become chronically red 
and inflamed, and the growth of the eyelashes affected. 
This occurs usually in children whose health has been 
impaired. 

Styes. — Small inflamed swellings on the edges of the 
lid, especially in older children, which form in a few 
days and then subside, or soften and discharge, or, finally, 
persist in the form of little tumors. Some children are 
very liable to have styes repeatedly, while others never 
do. Often the general health is at fault, and demands 
tonics; while in many cases, particularly in school-chil- 
dren, there is some defect of vision which needs exam- 
ination by an ophthalmologist. This is especially the 
case in children who constantly develop styes. For 
the relief of a stye already present the frequent applica- 
tion of small, very hot fomentations is the best method 
of treatment. 

Squint; Strabismus. — Strabismus may be either con- 
vergent, producing a condition of ' ' cross-eye, ' ' or di- 
vergent, so that one eye turns outward. Either one or 
both eyes may be affected. Of course, the mother can do 
nothing; but there is one thing she must not do, namely, 
neglect it. Not only does strabismus detract greatly 



2^6 THE CARE OF THE BABY. 

from a child's good looks, but it will finally produce 
great impairment of the sight of the aflfected eye. Treat- 
ment ought to begin very early in order to be of value. 
In infancy and early childhood the dropping of certain 
solutions into the eye may gradually correct the defect. 
In other cases the use of spectacles may be needed, or the 
performing of an operation which is not at all dangerous. 

Inflammation of the Ears ; Earache ; Running Ears. 

— Earache is, of course, only a symptom of different 
forms of inflammation of the ear which may or may not 
go on to the formation of pus. The child may develop 
pain suddenly in the night, although it was well or had 
only a slight cold in the throat or nose when it went to 
bed. The chief symptom in infants is loud, persistent 
crying, not relieved by anything, and sometimes made 
worse by pressure just in front of or just behind the 
affected ear. Occasionally a baby will raise its hand to 
the seat of pain. Older children can easily locate the 
pain, although they sometimes refer it to the teeth. 
There is usually fever and some degree of deafness. 
The pain may subside after a few hours, or may con- 
tinue with intermissions even for days. If pus is pro- 
duced, it will finally perforate the drum-membrane and 
be discharged, probably with relief of pain. If insuffi- 
ciently cleansed, the ear often has a very offensive odor. 
No medicine of any kind should be dropped into the ear, 
and no poultice or other wet application placed over 
it. A hot-water bag or bottle held to the ear will often 
remove the pain in a little while. Relief may be ob- 
tained by repeatedly syringing the ear with water as hot 
as can be borne, or the child may be laid on the sound 
side and the water be poured into the affected ear, which 
should then be covered with hot dry flannel. The pro- 




THE SICK BABY. 2'/y 

cedure must be repeated frequently. The child should 
be kept quiet and warm, and the temperature of the room 
should not be less than 70° F. The diet should be light. 
A laxative and a fever mixture (Appendix, 103) aid in re- 
lieving the inflammation. If the pain persists or if pus 
is discharged from the ear, it is best to consult a physi- 
cian, since, apart from the chances of permanent deaf- 
ness, there is always danger that inflamma- 
tion may extend to the brain. In cases of dis- 
charge from the ear the mother may very 
gently syringe the canal with warm water as 
often as is necessary to keep it clean, but 
should put no plug of cotton into it unless 
the child is going into the open air. The best 
syringe for her to use is a small bulbous one, Fic.ls^Ear- 
called the *' Ear and ulcer syringe," which is syringe. 
made of soft rubber throughout (Fig. 53). 

(4) DISEASES OF THE BONES, MUSCLES, SKIN, ETC. 

Deformities of tiie Head. — An alteration in the shape 
of the head may occur as a result of prolonged pressure 
received during birth. The deformity is due partly to 
the displacement of the bones and partly to swelling of 
the scalp (PI. III. , Fig. 2). Attention is called to it here 
because it is often the source of great though entirely 
needless anxiety on the part of the mother. If it is let 
alone it will be all right in a few days. On no account 
should any attempt be made to squeeze it into shape. A 
distorted and marked head is sometimes the unavoidable 
result of delivery by instruments. Here, too, the traces 
of deformity will usually disappear in a short time. In 
rare instances a large lump on the head, the size of an 
egg^ is caused by an accumulation of blood under the 
skin, or in other very unusual cases by a portion of the 



278 THE CARE OF THE BABY. 

brain protruding through an unnatural opening in the 
skull and elevating the skin over it. Such a deformity 
as the latter does not, of course, disappear. In hydro- 
cephalus and in rickets there is a deformity of the head 
characteristic of each respectively — in the one globular 
and in the other square (see PI. III., Figs, i and 3). 
These deformities are better considered in connection 
with other symptoms of the two diseases. 

Protruding Ears. — Mothers are often exercised greatly 
over a too great prominence of the baby's ears. Probably 
little alteration in the shape can be accomplished in most 
instances, and it is better not to meddle with them. A 
cap or a network bandage may be worn during sleep, to 
keep the ears from being bent by the pillow, and to press 
them inward somewhat. A slight operation may be 
performed in bad cases to bring the ears closer to the 
head. 

Deformed Hands and Feet. — Children are sometimes 
born with sitpermnnerary digits on the hands or feet, or 
with webbing between the fingers or toes similar to that 
seen in a duck's foot. Any operation required should be 
done early. 

Club-foot is a distorted shape of the foot, in which, 
most commonly, the front part of the foot is turned in- 
ward and the heel is raised. Sometimes there occur con- 
tractions of the foot into other forms. The condition 
may be present at birth or may be acquired. Treatment 
should begin immediately and be persevered with. The 
application of a splint or of some apparatus and the fre- 
quent manipulation of the foot will effect a cure in many 
cases. In others there must be an operation as well. 

Ingrowing toe-iiail is a condition in which the edge 



3 

t? n 



^^ 







•HI 3XV1J 




THE SICK BAB K 279 

of the nail, usually of the great toe, is pushed into the 
flesh, which rises above it. It will not develop if the 
shoes have been made of proper size and shape and the 
toe-nails have been cut according to the directions already 
given. Should the deformity be already present, a small 
quantity of cotton should be packed under the corner of 
the nail, in order to raise it above the flesh. The nail 
must be cut square or, still better, concave across, with 
a notch in the centre (Fig. 54), and should also be 
scraped thin down the middle with the edge 
of a knife. The corners should never be 
rounded off. If the disease has advanced 
too far for this plan of treatment, the advice 
of a physician must be had. 

Fig. 54.— 
Hip-joint Disease. — A tubercular inflam- Method of cutting 
mation of the hip-joint, the results of which an ingrowing toe- 
are so serious that every mother should be 
on the alert to recognize its insidious onset. One of 
the earliest symptoms is pain, in some cases situated 
in the hip itself, but very often felt only in the knee. 
The child is prone to start suddenly from sleep, suffering 
from pain. Very soon some degree of lameness comes on, 
lasting at first for a few days at a time. The child often 
tries to rest the affected hip by standing on the sound leg. 
Parents often make a fatal mistake at this period by at- 
tributing the symptoms to the existence of ''growing 
pains" and of weakness of the knees. A physician 
should be called in without delay, for the recovery is 
tedious at the very best. In many cases abscesses form, 
and even life is lost. 

Curvature of the Spine. — There are three forms of 
this affection, very different in* nature and cause, which 



28o 



THE CARE OF THE BABY. 



may be mentioned here. In the first, called lateral 
curvature^ the spine makes an S-shaped curve, as shown 
by the illustration (Fig. 55). Rickets is the commonest 
cause in young children, while a faulty position in sitting at 
school, or the carrying of some weight (as a baby-brother 




Fig. 55. — Lateral curvature of the spine. 

or baby-sister) always upon the one arm, produces it 
in older children. It is much commoner in girls than in 
boys. Mothers should not fail to examine their children 
for the defect at intervals. The disease consists in weak- 
ness of the articulations and muscles rather than of the 
bones. The treatment must be directed by a physician. 
Such gymnastic exercises and the assumption of such 
positions are required as will mechanically correct the 
deformity. 



THE SICK BABY. 



281 



The second variety of curvature, called caries of the 
spine ^ Pot f s disease^ or angular curvature.^ is due to tu- 
bercular softening and destruction of the bones of the 
spine, and is of so grave import that its earliest symp- 
toms should be reported to the physician. It is rare before 
the age of two years. A fall or blow seems sometimes to 




Fig. 56, — Slight degree of curvature of the spine, from a case of Pott's disease. 

start the process, but the majority of cases are in no way 
due to injury. One of the earliest symptoms is a pecu- 
liar stiff, tottering walk with a tendency to fall forward. 
The child moves the back rigidly and as a whole in order 
to avoid any jarring. It will not bend the back to pick 
up anything from the floor, but does it by bending the 
knees. If the trouble is higher in the spine, the shoulders 
are sometimes carried ' ' shrugged up ' ' and the neck 
stiff. Where the disease is low in the spine the child 



282 



THE CARE OF THE BABY. 



sometimes has a disposition to walk leaning forward, with 
the hands at times upon the thighs. Pain felt at the 
seat of trouble is usually present. Early in the disease 
pain is very often felt in the abdomen, and resembles a 
stomach-ache caused by indigestion. Sooner or later 
there develops a slight prominence of the spine which 
only a skilled eye may detect. Eventually the promi- 
nence becomes quite visible (Fig. 56), and it may even 
result in great deformity. 

The third form, the rickety posterior curvature^ occurs 
in severe cases of rickets in infancy (Fig. 57). It is due 

to the same articular and mus- 
cular weakness which produces 
lateral curvature, but it consists 
of a very long rounded curve 
extending posteriorly and oc- 
cupying nearly the whole length 
of the back, while in Pott's dis- 
ease the curve is at first more 
angular, short, and small. 

Ulceration of the Navel. — 

Instead of drying up properly 
the navel cord sometimes be- 
comes soft and ill-smelling and 
leaves a large ulcer after falling 
off. In some cases a pea-sized 
red protuberance can be detected 
within the navel, and from this comes a little discharge 
which irritates the surrounding skin. Frequent thorough 
dusting with a powder consisting of boric acid and oxide 
of zinc (Appendix, 90) will often effect a cure promptly. 
If not, the family physician may have to cauterize the 
ulcer, or perhaps cut off the protuberance. 




Fig. 57 



-Rickety curvature of 
the spine. 



THE SICK BAB V. 283 

Bleeding from the Navel. — Severe hemorrhage from 
the cord occasionally takes place some hours after birth ; 
or later, after the cord has fallen off, hemorrhage may 
occur from the navel itself. In the former case the cord 
should promptly be tied again between the body and the 
point from which the blood seems to come; in the latter 
the bleeding point must be firmly compressed between 
the finger and thumb until a physician can be obtained. 

Birth-marks ; Mother's-marks. — Under this heading 
are included both n<^m^ as physicians call them, and 
moles. A itcsvus consists of a red or purple patch on the 
skin, sometimes on a level with it, sometimes elevated 
above it. Although usually small, it is occasionally ex- 
tensive, and in some instances it is disposed to grow, and 
may then prove dangerous. A mole is a dark pigmented 
area in the skin, either flat or elevated, smooth or covered 
with hair. It is generally small, but sometimes is of 
sufficient size to cause great disfigurement. 

Contrary to the popular belief, birth-marks are in no 
way dependent, in the vast majority of cases, upon im- 
pressions made upon the mind of the mother before the 
child was born (compare page 25). Treatment can be 
prescribed only by a physician. Cauterization or some 
more serious operation may be needed, and some birth- 
marks cannot be removed at all. 

Warts. — These disfiguring growths are most common 
in children. They are apt to develop rapidly, and often to 
disappear quite as quickly without treatment. There is 
no good evidence that charms have any curative value 
whatever, and most of the applications recommended are 
equally useless. The warts are best let alone or cauter- 
ized by a physician. 



284 THE CARE OF THE BABY. 

Red Gum ; Strophulus. — Titles formerly applied to a 
red, pimply eruption from which babies often suffer 
during the first wee^s of life. The rash is generally 
either eczema or prickly heat. 

Prickly Heat; Miliaria. — A very common affection in 
infants, consisting of an eruption of numerous minute 
red elevations (papules), or of pinhead-sized, inflamed 
blisters (vesicles), or of both together (see page 296). 
These are closely crowded, particularly where there is 
much perspiration, as about the neck and over the trunk. 
The disease begins very suddenly and is attended by more 
or less burning and tingling, but seldom by the very in- 
tense itching of eczema. The latter affection, moreover, 
usually develops more slowly and its vesicles show a 
greater tendency to run together. Prickly heat is seen 
chiefly in hot weather, and especially in children who are 
too warmly clothed and who perspire profusely as a result 
of this. Treatment consequently consists chiefly in 
avoiding or removing the cause. The clothing must be 
made as cool as the child can wear with entire safety. 
It is particularly in children disposed to prickly heat that 
woollen underclothing must sometimes be replaced in 
summer by cotton material (see p. 86). The irritated 
skin may be dusted with a camphor-and-zinc powder 
(Appendix, 89) and the child given a laxative alkaline 
mixture (Appendix, loi) or a dose of magnesia and a 
light diet. Sometimes the itching is- relieved by a solu- 
tion of a teaspoonful of baking-soda in a pint of water 
dabbed on and allowed to dry. If recovery does not 
follow in a very few days, a physician's advice should 
be obtained. 

Eczema. — A troublesome disease, particularly common 



THE SICK BABY, 285 

in infants, lasting days, months, or occasionally even 
years, and limited to a large or a small area, or, in rare 
instances, covering the entire body. The special tend- 
ency to sufifer from it disappears in most cases by the 
end of the first year, although it is frequent at all 
periods of life. Among the principal causes are inherited 
tendency, debilitated constitution, imperfect hygiene, im- 
proper diet (particularly in infants the early use of 
starchy food), digestive disturbances, the eruption of a 
tooth, irritating soap, the contact of soiled diapers, any 
other local irritation, etc. Often no cause can be dis- 
covered. The commonest situations are about the head, 
the crotch, the groins, and the folds of the joints in gen- 
eral. In the most frequent form the skin becomes bright 
red and covered ^yith minute, pinhead-sized vesicles. 
These soon rupture, leaving the surface swollen, red, and 
moistened with a watery discharge which may thicken 
and form crusts with raw flesh beneath. In another 
form the skin is dry, red, thickened, and somewhat 
scaly, and perhaps cracks easily. In still another com- 
mon variety numerous small pustules develop; while 
in another the eruption is chiefly composed of papules 
(see p. 296). The attack is attended by itching which is 
often so intense that the child is nearly frantic. This is 
generally worse at night, and may prevent sleeping. 
Owing to the disposition of the rash to spread, every 
case should early be put under a physician's care. The 
treatment open to the mother is to remove the cause if it 
can be found. Besides this she may give a laxative at 
the outset, reduce the quantity and the strength of the 
food, hinder scratching by putting the hands into mittens 
or even by fastening them to the sides, prevent any 
friction of the skin from rough clothing, cease to employ 
soap, use no more water on the diseased part than is 



286 THE CARE OF THE BABY. 

absolutely necessary, and employ a lotion of starch and 
boric acid instead of plain water for cleansing (Appen- 
dix, 78). The skin, if red and weeping, may be dusted 
frequently with a drying powder (Appendix, 91). Sur- 
faces which touch each other must be separated by 
placing between them a thin layer of absorbent cotton 
or patent lint well filled with the powder. Soaking in 
sweet oil may be employed to remove any crusts. 

Hives; Nettle-rash; Urticaria. — Few or numerous 
distinct raised blotches, pinkish or whitish in color, and 
of a size which, although having a considerable range, 
averages that of the finger-nail. They often resemble 
closely the elevations produced by the stings of insects. 
A crop of hives comes out with great suddeness, lasts 
a few hours or a day, and is then, perhaps, succeeded by 
another, the whole attack persisting for two or three days 
or sometimes becoming chronic. The burning and ting- 
ling are often intense. The commonest cause is some 
disturbance of digestion. Sometimes one certain article 
of diet will, without affecting the digestion, always pro- 
duce nettle-rash in one child, and another article will 
have the same ej0fect in another child. Among the foods 
most apt to act in this way are fish, shell-fish, straw- 
berries, pineapples, mushrooms, and sausages. Some- 
times the presence on the skin of a single insect, as a 
hairy caterpillar or a flea, may bring out a large crop of 
hives. Contact with the stinging-nettle or with the jelly- 
fish may produce the rash. The treatment usually effi- 
cacious for mild cases consists in giving a dose of mag- 
nesia followed by a laxative alkaline mixture (Appendix, 
loi) and reducing the diet temporarily. The skin may 
be powdered frequently with camphor-and-zinc powder 
(Appendix, 89), or the spots dabbed with absorbent cotton 



i 



THE SICK BAB Y. 287 

wet with equal parts of vinegar and water or with a 
special cooling lotion (Appendix, 84). In cases which 
tend to be chronic or to recur frequently the great aim 
must be to search for and remove the cause. Starch-and- 
soda baths (Appendix, 44) often do great good, but the 
disease ought to be treated by a physician if it lasts more 
than a few days, as it is sometimes most difficult to cure. 

Chafing; Cracks; Roughness of the Skin; Chap- 
ping. — Chafing may occur wherever two moist surfaces of 
skin are constantly touching each other. It is common 
in the folds of the neck in fat babies, in the armpits, and 
about the buttocks, thighs, and groins. In the latter 
localities it is liable to be produced by a too infrequent 
changing of diapers, particularly if there is a sour diar- 
rhoea. When the attack is severe the skin is bright red, 
tender, moist, and looks almost raw. In children dis- 
posed to it the disease may be prevented by ensuring 
great cleanliness and by the use of starch-water for wash- 
ing, followed by a thorough drying and dusting with a 
talc powder. When there is diarrhoea, the free applica- 
tion of vaseline helps to keep the skin from becoming 
moist. To cure chafing already present the methods 
mentioned must be followed, and, in addition, pieces of 
lint previously dusted with an astringent powder (Ap- 
pendix, 91) should be placed in the folds between the 
affected surfaces. 

Cracks are generally produced in the same way as 
chafing, and are in reality of the same nature. Those in 
the folds of the neck are sometimes very difficult to heal. 
The frequent application of a hot wet sponge followed by 
careful drying may be of benefit. 

A general rough^iess of the skin is generally best treated 
by thorough rubbing with olive oil or vaseline after bathing. 



288 THE CARE OF THE BABY. 

Chapping of the hands and face usually results from 
exposure to cold. It is best prevented by protecting 
with veil and gloves. The treatment is much the same 
as for roughness of the skin. 

Stomach-rash ; Tooth-rash. — Terms often used by 
mothers to designate many sorts of rashes seen in 
infants. They are more properly applied to an erup- 
tion of erythema^ that is, of a diffuse redness or of dis- 
tinct, pea-sized, scarcely elevated spots which appear 
very suddenly, last a few hours or days, and produce no 
irritation. This often develops in infants suffering from 
some digestive disturbance. Treatment is generally not 
required, other than that for the indigestion. 

Boils and other Pustular Eruptions. — In a strictly 
medical sense, a boil, or furuncle^ consists of an elevated, 
rounded or conical, dusky-red, painful, and very tender 
swelling which contains pus. When it bursts it is found 
to have a distinct ' ' core ' * of dead tissue. Furuncles 
may be single, but are very apt to occur several at a 
time and in successive crops. Impairment of the gen- 
eral health or, in babies especially, chronic digestive dis- 
turbance causes them in many cases, but some children 
have a peculiar predisposition to them, although ap- 
parently well in other respects. The disease, however, 
is never a sign of robust health, as has sometimes been 
supposed. 

There are various other pustular eruptions which are 
popularly known as ' ' boils, ' ' but which are named 
otherwise by physicians. Some of these are the result 
of most unfavorable hygienic conditions; others are evi- 
dences of eczema; others occur entirely independently of 
any affection of the general health or digesticn ; others 



Plate IV. 




Girl with measles, showing the characteristic grouping of the eruption and the peculiar 
heavy and swollen appearance of the face. (From a photograph.) 



THE SICK BABY. 289 

constitute a peculiar acute contagious disease; and still 
others are the result of syphilis. The only treatment of 
pustular eruptions which is justifiable without the advice 
of a physician is the protecting of the affected parts or 
the smearing them with a little ichthyol. Poultices must 
never be applied unless ordered. When used, they should 
be mixed with a boric-acid solution (Appendix, 75) in- 
stead of with plain water, or, still better, the dressing 
should be the antiseptic poultice described later (Appen- 
dix, 62). Tonic treatment and change of air are needed 
in many cases. 

Fever-blisters. — Small groups of minute, closely- 
crowded blisters (vesicles, see p. 296) which contain a 
clear watery fluid, and which, if not ruptured, dry into a 
crust. In many children slight fever, such as accom- 
panies a cold or indigestion, will invariably produce 
them. They are generally situated on the lips or the 
edges of the nose, although in bad cases they may spread 
over the face or below the chin. The spots should be 
smeared twice a day with ichthyol or with a zinc-and- 
bismuth ointment (Appendix, 68). 

Dandruff; Milk-crust. — Young babies often show a 
tendency to an excessive production of oily scales upon 
the head. Unless carefully watched, these will accumu- 
late in large yellowish patches commonly called the 
milk-crust. Some mothers have a mistaken notion that 
this should be carefully let alone. Great cleanliness will 
prevent any such accumulation, and rubbing the head 
daily with a boric-acid ointment (Appendix, 70) will 
often check the excess of oily secretion. A patch already 
formed should be removed by soaking it with warm olive 
oil and then washing it with Castile soap and warm 

19 



290 THE CARE OF THE BABY. 

water. A fine-tooth comb should never be used on it. 
When the patch is found to have a raw, weeping surface 
beneath it, it is not simply milk-crust, but is eczema, and 
should be treated accordingly. 

In older children there is often a production of dryer 
scales, or dandruffs which are without the very oily cha- 
racter, and which consequently fly about when the hair 
is brushed. The scalp should be washed frequently with 
water and one of the German salicylic-acid or sulphur 
superfatted soaps. If dandruff persists, a physician must 
be consulted, since falling of the hair may follow. 

Ringworm. — A common and very contagious affection, 
due to a microscopic, mould-like, fungous growth. On the 
face and body it occurs much most frequently in child- 
hood, and on the scalp it is found only at this time of life. 
In the former situation it consists of a single dull-red, 
more or less circular spot, which gradually enlarges into a 
patch with a red, somewhat scaly border and a paler, more 
natural centre. This ring-like shape gives the name to 
the disease. On the scalp, which is by far the commonest 
situation, the patches are numerous, circular, and little, 
if at all, red. The hair comes out, leaving the spots 
more or less bald, and often covered with fine scales and 
with short, brittle stumps of broken hairs which can be 
pulled out easily. This latter is a characteristic symptom. 

Ringworm of the scalp is so difficult to cure and so 
tedious at the best that no mother should dream of un- 
dertaking its treatment. Her province is to follow direc- 
tions carefully and to see that other children, her own as 
well as those of other people, do not catch it. The 
affected child must on no account be sent to school, and 
all its toilet articles must be kept strictly for its own use. 
Some sort of skull-cap may be worn to prevent the germs 



Plate V. 




Child with well-developed rickets suffering also from chicken-pox, showing the contracted 
■chest, swollen abdomen, and enlarged wrists of the first disease, and the characteristic rash 
•of the second. (From a photograph.) 



THE SICK BABY. 29 1 

from getting about. The sooner a physician sees the 
case the greater the chance of getting it under control. 
Ringworm of the body is much more easily cured. An 
ointment such as that given in the Appendix (69) may be 
rubbed into the spot twice a day for a week or longer; 
but here, too, a wise mother will not undertake the care 
of the case herself. 

Itch ; Scabies. — An intensely itching and very con- 
tagious affection of the skin, due to the presence of a 
minute insect which burrows under the surface. The 
disease may attack any age from infancy up. Although 
commonest among the poor and dirty, it may by contact 
with them be contracted by the cleanest child. Exam- 
ination shows scattered, small pimples, which may oc- 
cupy any part of the body, but which are usually first 
found on the sides of the fingers. The toes, armpits, 
buttocks, and the central parts of the body are also 
favorite seats. Sometimes a few irregularly shaped 
ridges, one to ten lines long, show themselves here and 
there and make the diagnosis certain. They are the bur- 
rows in which the female insect lays her eggs. Often, 
however, the itching is so intense, and the skin so irri- 
tated and torn by the scratching which this incites, that 
the original characteristic appearance is destroyed and 
the diagnosis may be difiBcult. If several children of one 
family, and perhaps the parents as well, are suffering 
from an itching eruption, it is pretty certain that the 
disease is the itch. Treatment is almost beyond the 
power of the mother, for the applications necessary some- 
times produce decided irritation which must be checked. 
As contagion takes place by the clothing and the bed- 
linen, particular attention must be given to their disin- 
fection. 



292 THE CARE OF THE BABY. 

Lice; Pediculi. — Although these little insects are by 
right the inhabitants of the unwashed, any child, no 
matter how clean, may be infected by them through some 
accidental contact with another. When once in posses- 
sion, they are not killed by the simple washing of the 
head with soap and water. The first symptom is a very 
decided itching of the scalp. The scratching which this 
causes, and the irritation by the animals themselves, set 
up an inflammation, and produce pustules and matting 
of the hair if the case is severe. Eczema situated at the 
back of the head is in most cases the result of the pres- 
ence of lice. Careful inspection shows the minute oval 
eggs (7iits) attached by one end to the hairs. The careful 
use of a fine-tooth comb will probably remove some of 
the animals themselves. Many different applications are 
equally serviceable, but some of them are quite irritating. 
One of the safest and most popular is the ointment of 
stavesacre (larkspur-seeds), which should be rubbed upon 
the scalp several days in succession. Kerosene is also a 
good application, but must not be applied near a flame 
of any sort. The hair meanwhile should be washed re- 
peatedly with vinegar in order to destroy the nits. With 
proper care long hair need not be cut. 

There is one species of lice — body-lice — which infests 
the clothing only. The remedy consists in entire de- 
struction or baking of the infested garments and the 
placing of the child in a disinfectant bath (Appendix, 

95)- 

(5) INFECTIOUS DISEASES. 

Of the numerous infectious diseases, we may consider 
typhoid fever, small-pox, chicken-pox, vaccination, 
scarlet fever, measles, German measles, diphtheria, 
mumps, and whooping-cough. 

They are called infectious because due to microscopic 
germs which are capable of being transmitted from per- 



THE SICK BAB V. 293 

sons with the disease or from other sources and of infect- 
ing the system of others. Some diseases are contagious 
as well as infectious. Malaria is an instance of one 
which is infectious because due to a microscopic germ, 
but which is not contagious because it cannot be con- 
tracted from another person. All the diseases enumer- 
ated above are both contagious and infectious. The 
infection may be by direct contact, or the germs may in 
some cases be carried by another person or by water, food, 
clothing, books, letters, etc. The germs of some of the 
diseases have a great tenacity of life. A case of con- 
tagious disease is always the result of some other case 
from which the contagion comes, even though we are 
not able to trace the connection. All of the diseases 
mentioned, with the possible exception of whooping- 
cough, are accompanied by more or less fever. Some of 
them are called eruptive fevers^ because there is a cha- 
racteristic eruption or rash upon the skin. Treatment is 
entirely the province of a physician. There is absolutely 
no way known to avoid contracting them except by 
keeping away from the contagion. The carrying of 
disinfectants about the body, such as bags of camphor or 
carbolized substances, is entirely useless. The recogni- 
tion of the existence of one of the infectious diseases is 
beyond the mother's skill in many instances, while in 
others it is comparatively easy. The table which fol- 
lows gives in convenient form information regarding 
these diseases, which will be of value to a mother de- 
sirous of understanding something of their nature. 

Physicians use certain terms as applied to infectious 
diseases, which may conveniently be described in this 
connection. The day of the disease — as the " first day '^ 
or the "third day" — is in accord with the ordinary 
method of dividing time, and does not indicate the num- 



294 



THE CARE OF THE BABY, 

TABLE OF INFEC 



Disease. 


Incubation 
lasts— 


Date of 

Characteristic 

Symptom from 

beginning of 

Invasion. 


Characteristic Symptom. 


Typhoid 
fever. 


About 14 days. 


7th or 8th day. 


Rose-red, slightly elevated spots. 


Scarlet 
fever. 


I to 7 days. 


1st or 2d day. 


Intense, bright -red blush over 
body. 


Measles. 


12 to 14 days. 


4th day. 


Dusky or purplish - red, slightly 
elevated spots, scattered and in 
characteristic groupings. 


German 
measles. 


7 to 21 days. 


1st day. 


Pale, rose-red spots or uniform 
blush; no characteristic group- 
ings. 


Chicken-pox. 


13 to 17 days. 


1st day. 


Pea-sized, scattered vesicles. 


Varioloid 
(Variola). 


10 to 14 days. 


3d day (may 
be 1st or 2d). 


Red, elevated papules ; then ves- 
icles; then often pustules. 


Vaccinia 
(Vaccina- 
tion). 


I to 2 days. 


1st day (3d 
after vacci- 
nation). 


A red papule, becoming a vesicle 
and then a pustule ; surrounded 
by a broad red area. 


Erysipelas. 


3 to 7 days. 


1st or 2d day. 


Bright-red blush ; puffy skin ; often 
blisters. 


Diphtheria. 


2 to 12 days. 


1st or 2d day. 


White membrane on tonsils and 
other parts of throat. 


Whooping- 
cough. 


2 to 7 days. 


7th to 14th 
day. 


A prolonged paroxysm of cough- 
ing followed by a crowing in- 
spiration (whoop). 


Mumps. 


7 to 21 days. 


1st day. 


Swelling in front, below, and be- 
hind the ear and below the jaw. 



ber of times twenty-four hours have elapsed since the 
symptoms first appeared. Thus, if the onset of symp- 
toms occurred, for instance, at 10 p. m. on Tuesday the 
14th, the "second day of the disease" does not begin 
with 10 P. M. on the 15th, but is counted from midnight 
of the 14th — the time when Wednesday the 15th begins, 
although this is only two hours after the onset. The 



THE SICK BABY. 
TIOUS DISEASES. 



295 



Other Principal Symptoms. 


Whole Duration 
of Disease 
from Onset. 


Quarantine lasts 
from Onset — 


Apathy ; diarrhoea ; nose - bleed ; 
headache. 


2 to 4 weeks. 


While disease lasts. 


Sore throat; often vomiting with 
onset. 


7 to 9 days or more 
(not including des- 
quamation). 


6 weeks at least. 


Cold in head; running eyes; 
cough J hoarseness. 


7 to 8 days. 


3 weeks. 


Slight sore throat; slight running 
of eyes and nose. 


3 to 4 days. 


3 weeks. 


None ; or slight fever. 


A week or less. 


3 to 4 weeks. 


Headache; backache; vomiting. 


About 14 days. 


4 to 8 weeks. 


Often feverishness and malaise. 


About 3 weeks. 


None. 


Fever; pain. 


4 to 6 days, or several 
weeks if it spreads. 


Averages 2 weeks. 


Debility; fever. 


10 to 14 days. 


3 to 4 weeks. 


Vomiting; spitting of blood. 


6 to 8 weeks 


6 to 8 weeks, (while 
whoop lasts). 


Pain when chewing. 


A week or less. 


3 to 4 weeks. 



stage of incubation denotes the period which elapses 
between exposure to contagion and the appearance of the 
first symptoms. The stage of invasion is the time fol- 
lowing incubation, in which there are distinct evidences 
of illness, although the characteristic symptom (such 
as the eruption in measles or the whoop in whooping- 
cough) has not appeared. Symptoms seen during this 



296 THE CARE OF THE BABY. 

period are called prodromal or initial. The first day of 
invasion marks the onset of the disease, and from this 
day the duration of the disease is dated. Next comes 
the stage of characteristic symptoms called the eruptive 
stage in the case of eruptive fevers. Sometimes the 
invasion lasts less than a day, as, for instance, in chicken- 
pox, and the characteristic symptoms then appear on the 
first day of the disease; that is, there is no evident stage 
of invasion. Desqiiamatio^t is the shedding of the skin 
which follows in some of the fevers. The duration of the 
contagiousness, throughout which the child should be 
kept from mingling with others, is sometimes called the 
period of quaranthie or of isolation. 

Certain other terms are used in speaking of some of the 
eruptive fevers and of certain skin diseases. A vesicle is 
a little elevated blister, the size of a split pea or smaller, 
filled with a clear, watery fluid. A macitle is a small red 
spot not elevated above the skin. A papule is a red, 
pimple-like elevation. A pustule is shaped like a papule 
or a vesicle, but contains pus. 

The following is a much abbreviated review of the 
infectious diseases, supplementary to the table and con- 
taining chiefly facts not mentioned there. 

Typhoid Fever. — As frequent in children as in adults, 
but less severe; less common under three years of age, 
and occurring oftenest in autumn. It is but slightly con- 
tagious, for it is transmitted only by the germs from the 
bowel-movements contaminating the drinking-water or 
the food of others. As a rule, one attack protects from 
subsequent ones. Symptoms of invasion begin very 
insidiously with debility, loss of appetite, fever, and 
often diarrhoea and nose-bleed. Sometimes, especially in 
children, the onset is much more sudden. The fever 



THE SICK BABY. 297 

gradually increases for a week, then stays high (103° to 
104°) for a week or two, but with a very characteristic 
difference between the morning and evening temper- 
atures, and then gradually diminishes. Very frequently 
children scarcely feel sick at all, and the disease in them 
may stop much short of the usual three weeks. Diar- 
rhoea is not very common in children. The characteris- 
tic rose spots are usually only few and are not always 
present. They are found solely or chiefly on the trunk, 
and especially on the abdomen, come in successive crops, 
and continue to appear until the middle of the third 
week or for a shorter time. They are slightly elevated, 
oval, rose-red, and about one-sixth of an inch long, and 
disappear momentarily when pressed upon. Inflamma- 
tion in the bowel is always present, and ulcers are liable 
to form; and if the thin, paper-like wall of one of these 
ulcers perforates, death almost certainly follows in a few 
hours. We can easily see, then, the tremendous import- 
ance of very soft food, especially milk, and of absolute 
rest in bed and the use of a bed-pan, no matter how 
slightly sick the child may seem. Since the germs are 
contained in the passages only, these should be covered as 
soon as passed, and be disinfected promptly (Appendix, 
93). The bed-linen and bed-clothes also ought to be 
disinfected. 

Scarlet Fever; Scarlatina; Scarlet Rash. — The dif- 
ferent names mean exactly the same. The disease is one 
of the commonest affections of children, occurs at any 
time of year, is rare under the age of one year and espe- 
cially under that of six months, and is very contagious, 
yet less so than measles. The germs are transmitted by 
the breath and the skin, and can be carried in the cloth- 
ing from the sick to the well. Their vitality is remark- 



298 THE CARE OF THE BABY. 

able, for, attached to some garment, they may live even a 
year. A second attack is of great rarity, for in nearly 
every supposed instance of it the child really had some 
unrecognized rash on one of the occasions. The disease 
may be so mild that it is overlooked, or so severe that the 
child dies in a few hours. The lightest case is capable 
of giving the most severe form to other children. In a 
case of average severity the first symptoms are vomiting, 
fever, rapid pulse, and sore throat. The rash appears 
within twenty-four hours, and often first about the neck, 
but rapidly spreads over the whole body except the face. 
It consists of minute red points, not at all elevated, and 
so closely crowded that the skin appears a uniform bright 
red. As a rule, the eruption is widespread when the 
child is first examined. The color increases in intensity 
for two or three days, begins to fade in three or four days 
after the onset, and lasts in all about a week. At about 
the end of the first or second week the skin begins to peel 
in large or small shreds, and this characteristic desquama- 
tion continues several weeks. During the height of the 
disease fever persists, the throat is sore, swollen, bright 
red, and often seriously inflamed, and the tonsils may be 
covered with white patches resembling diphtheritic mem- 
brane. The tongue loses its coating and becomes bright 
red with the minute natural prominences unusually large 
("strawberry tongue"). The rapidity of the pulse is 
greater than the elevation of the temperature would lead 
one to expect. The fever disappears in seven to nine days, 
and the acute stage is over. In bad cases with severe 
throat-symptoms fever may last much longer than this, 
while in the mildest cases the rash may disappear in 
twenty-four hours and there may have been but the slight- 
est fever. The disease is always alarming, because the 
cases which begin mildly may eventually become severe, 



THE SICK BABY. 299 

or be followed by inflammation of the ears, pneumonia, 
abscesses of the glands in the neck, or Bright' s disease. 
The last-mentioned disease may come on even after the 
child has been convalescent from the fever for two or 
three weeks. It must be guarded against with especial 
care. 

In the way of treatment, the slightest possible chance 
of taking cold must be avoided. The child should be con- 
fined to bed, and the windows must not be opened in the 
slightest, or any bathing or sponging employed, until the 
doctor in charge is asked what he wishes done in the 
matter. Very often he will have the child oiled all 
over as an additional safeguard against cold and to keep 
the desquamating and very infectious skin from getting 
about the room. Further preventive measures against 
spreading consist in isolating the child the moment the 
mother suspects that it may have scarlet fever, in carry- 
ing out careful disinfection during the attack, and in de- 
ferring the removal of quarantine until she is quite sure 
that the danger is over. The caution about bathing is 
given not because it expresses the writer's views on its 
danger, but because some physicians are greatly opposed 
to all bathing in this disease. It does not apply to the 
first hot bath, useful at the beginning of nearly any acute 
disease in children. 

Measles; Rubeola; Morbilli. — Probably the most fre- 
quent and most contagious of the eruptive fevers; occur- 
ring oftenest in the cold season, and rarely in babies 
less than one year, or, especially, six months, old. It 
appears to be contagious even during the period of in- 
cubation. It is caught generally from the breath, for, 
although the infection can cling to objects about the 
patient and be carried by a third person, this occurrence 



300 THE CARE OF THE BABY. 

is certainly very rare. The germ has little vitality as 
compared with that of scarlet fever. Second attacks of 
measles, although more frequent than is the case with 
scarlet fever, are still very unusual. In nearly all the re- 
ported instances so often heard of the children had measles 
upon one occasion and German measles or some skin afifec- 
tion upon the other. Measles is usually regarded as a dis- 
ease of little consequence; but this is an error. In children 
not previously in good health it may prove fatal, gener- 
ally by inducing pneumonia, tuberculosis, or some other 
complication. The attack begins with all the symptoms 
of a very bad cold, such as feverishness, sneezing, run- 
ning of the nose and eyes, heavy, stupid expression of the 
face, hoarseness, and cough. The child is so often stupid 
and sleepy that the expression ' ' sleeping for the measles ' ' 
has become a common one. Frequently the onset is 
much milder, and the child is out of doors, ver}^ slightly 
sick. The rash begins upon the fourth day of the dis- 
ease, in the form of purplish-red, slightly elevated, flat- 
tened papules about the size of a split pea. These ap- 
pear first upon the face, but spread over the entire body 
in about twenty-four hours. Many of them remain dis- 
tinct, while others unite by their edges and form irregu- 
lar blotches and lines many of which are crescent-shaped. 
This grouping is very characteristic of the disease. Plate 
IV. is from a photograph of a child with measles, and 
shows very well both the nature of the eruption and the 
heavy, somewhat swollen face and thickened lips. All 
the symptoms mentioned persist or grow worse, and 
there may also be diarrhoea. By the sixth or seventh 
day of the disease the fever has ceased, and by the 
seventh or eighth day the rash has disappeared. There 
is often a faint mottling and a fine desquamation of 
branny scales lasting a week after the rash has disap- 



THE SICK BABY. 3OI 

peared. There is no peeling as in scarlatina. At the 
beginning of the attack a hot bath may be given, but other 
treatment will be directed by the physician. It is best to 
keep the child in bed about ten days, to avoid the danger 
of taking cold. Bright light should be excluded, since 
the eyes are inflamed. 

German Measles; Rubella; Rbtheln. — The term 
"French measles" is only an incorrect name for this 
disease. "Roseola" is another term very loosely used, 
and applied to other affections as well. German measles 
is just as distinct from ordinary measles as scarlet fever 
is. That a child has suffered from one of the three dis- 
eases protects it in no way from the other two. It is less 
common than these, oftenest seen in the winter-time, very 
contagious, rarely occurs twice in one person, and seldom 
attacks children under one year old. The contagion is 
transmitted as in measles. The disease is quite variable, 
in some cases resembling measles, and in others scarlet 
fever, so closely that even the attending physician cannot 
make a positive diagnosis. There are seldom any pro- 
dromal symptoms, or they are only those of a very slight 
cold, and are followed by the rash within twenty-four 
hours. This comes out first on the face as pale-rose, very 
slightly elevated spots, of the size of a pin-head up to that 
of a split pea, which do not run together into distinct 
small blotches as in measles, although they do very often 
fuse into large areas of an almost uniform redness looking 
much like the rash of scarlet fever. The eruption spreads 
rapidly downward over the body, like a wave in that it 
fades rapidly also, and may have nearly disappeared from 
the face by the time it is fully out on the feet. It is gone 
from every part by the third or fourth day. The symp- 
toms during the presence of the rash are very moderate 



302 THE CARE OF THE BABY. 

fever with slight running of the eyes and nose and slight 
sore throat. Desquamation of a few branny scales often 
follows the rash. Care must be taken to guard against 
cold, as bronchitis or pneumonia may develop. 

Chicken-pox ; Varicella. — A very common and con- 
tagious disease, rarely occurring twice in one person, and 
not so often attacking those under six months of age — 
although this last is less true of it than of measles and 
scarlet fever. It resembles the mildest varioloid very 
closely, but is an entirely distinct disease. Contagion is 
transmitted by the breath or scabs, and very exceptionally 
it is possible for a third person to carry it from the sick to 
the well. The disease is generally very mild. Prodro- 
mal symptoms are absent. The discovery of the charac- 
teristic rash is usually the first symptom, although some- 
times there is slight fever and malaise for a few hours 
before. The eruption consists at first of rose-colored 
spots which usually appear first on the neck and trunk, 
and which change in a few hours into prominent vesicles, 
from a few to hundreds in number, one-quarter of an 
inch or less in diameter, filled with a clear watery fluid, 
and sometimes surrounded by a slight red halo. The 
vesicles come out in crops, the older ones rapidly drying 
up and forming scabs. There may be mild fever during 
the presence of the eruption. The attack lasts a week 
or less, although all the scabs may not be gone for some 
time longer. Plate V., from a photograph, shows the 
vesicles dotted over the trunk in a case of chicken-pox 
with a moderate development of the rash. 

The child should be confined to the house, away from 
other children, or to bed if there is an extensive eruption. 
Other treatment is not often required. Care should be 
taken that the spots are not picked at or torn, as this 



THE SICK BABY. 303 

increases the danger of leaving scars. When the vesicles 
on the face are unusually large some attention must be 
given to prevent scarring. They may be punctured with 
a needle and then touched carefully with a solution of 
equal parts of pure carbolic acid and glycerin. This so- 
lution must not be allowed to spread over the face. It is 
poisonous if swallowed. The advice of a physician had 
better be asked about its use. 

Small-pox ; Varioloid. — Varioloid, or modified small- 
pox., is in reality a mild form of small-pox, modified by 
occurring in one who has been partially protected by 
vaccination. Small-pox in any form is, fortunately, 
becoming comparatively rare. The difference between 
the symptoms of the modified and grave forms are those 
of degree only. Either form may be caught from a per- 
son suffering with the other. The disease is very con- 
tagious, and the contagious principle, which arises chiefly 
from the skin, permeates the air about the patient, and 
has, besides, a remarkable tenacity of life, since it may 
stick to clothing for months or years. As a rule, one 
attack protects against a second, but instances of two or 
more attacks are quite numerous. It occurs oftenest in 
the cold season. It is less frequent during the first year 
of life, although it may sometimes attack children even 
before birth. The symptoms of the invasion consist, 
if well marked, of more or less headache, pain in the 
back, high fever, drowsiness, vomiting, and sometimes 
convulsions. A red flush over the skin may be present. 
Sometimes, however, the initial symptoms are so mild 
that they are unnoticed. The eruption appears on the 
third day of the disease, or sometimes, in varioloid, on 
the first or second day. It first consists of spots which 
feel like shot under the skin, appear on any part of the 



304 THE CARE OF THE BABY. 

body, grow more prominent by the time they are a day 
old, and on the next day — the fifth of the disease — be- 
come projecting, red, conical papules with a little clear, 
watery fluid at the apex. Very quickly the whole papule 
now becomes filled with clear fluid (vesicle). This is 
very unlike chicken-pox, in which there is never any 
shot-like sensation and in which the spots are full of fluid 
almost from the beginning. The vesicles of typical 
small-pox now go on to produce pus (pustules), but in 
varioloid many of the papules never form vesicles, while 
most of the vesicles which do form begin to dry up and 
produce crusts by the eighth or ninth day of the disease, 
without going through the pustular stage. Some of the 
vesicles, however, do pustulate, and are not only longer 
in producing the scabs, but also leave marks afterward. 
The scabs begin to fall by about the fourteenth day. The 
fever and the other initial symptoms usually disappear 
when the rash comes out, but return in typical small-pox 
when the eruption becomes pustular. Contagion certainly 
lasts until every trace of scabbing has disappeared and 
thorough disinfection has been made, but the contagious 
power is so strong that it is best to quarantine the pa- 
tient for eight weeks. Isolation and disinfection should 
be prompt and perfect, and everybody in the house 
should be re-vaccinated at once. The treatment must 
be left entirely to a physician. 

Vaccinia; Cow-pox; Vaccination. — Vaccinia prob- 
ably is small-pox occurring in cattle, but so modified by 
this fact that when introduced by "vaccination" into 
the human body it produces only a single sore, although 
it protects the whole system from a general attack. The 
fact that small-pox made such frightful ravages before 
vaccination was practised, yet is comparatively uncom- 






THE SICK BAB V. 305 

mon now^ is positive proof of the value and the great 
importance of vaccination for ever}^ child. The sup- 
posed dangers of transmitting other diseases by vaccina- 
ting with human lymph are largely imaginary, and with 
the calf (bovine) lymph they no longer exist. The 
danger of erysipelas or of blood-poisoning setting in is 
little if any greater from vaccination than from a scratch 
or sore of any other nature. The best time to vaccinate 
is at about the age of two or three months, provided the 
child has no skin eruption and is in good health in other 
respects. Girl babies should certainly not be vaccinated 
on any part of the arm where the scar will show in later 
years. The thigh or the leg is a very desirable place. 

After vaccination nothing is seen until the second or 
third day, when a red papule appears, which grows 
larger, and which by the fifth or sixth day after vaccina- 
tion has become a vesicle filled with a watery fluid. This 
increases in size until the eighth day, when it is nearly 
as large as a ten-cent piece. By the tenth day the 
vesicle has become a pustule, with its contents yellowish 
and cloudy, and with a broad red ring two to three inches 
in diameter surrounding it. By the eleventh or twelfth 
day the redness lessens and the fluid begins to dry; by 
the fourteenth day the scab is pretty well formed; and by 
the end of three weeks or thereabouts this falls off" — if, 
indeed, the child has not rubbed it off" before — and leaves 
a scar which finally becomes white and pitted. Generally 
there is some fever by the third or fourth day after vacci- 
nation. This persists, perhaps with restlessness and irrita- 
bility, until the eighth or tenth day. Sometimes a child 
seems quite sick. After the vesicle begins to form it 
should be guarded against injury by covering it with a 
pad of salicylated absorbent cotton fastened on loosely 

with a roller bandage or adhesive plaster. This is better 
20 



306 THE CARE OF THE BABY. 

than most of the vaccination shields in the market, since 
these are difficult to keep in place. Often the doctor pre- 
fers to apply the cotton immediately after vaccination, in 
order to guard against any possible, although remote, 
danger of blood-poisoning. If the vaccination does not 
*'take," it must be repeated until it does. It is only 
very rarely that the effort will not at last succeed. 

Most children who have been successfully vaccinated 
will never develop small-pox, but in others the protection 
ceases to a certain degree after a number of years, and 
they may contract varioloid. Absolute protection may 
be counted as lasting about seven years. A child should 
therefore be re- vaccinated at the age of seven years, and 
again at that of fourteen years. When small-pox is prev- 
alent every one in the house should be vaccinated who 
h^s not had it done successfully within a few years. 

Erysipelas. — This disease may attack any age, is com- 
monest in early spring, and is contagious to a limited 
extent only. It develops usually about a wound, even 
though it be a very small one; consequently in early 
infancy it is generally seen about the navel. When not 
about a wound, it occurs oftenest on the face. The con- 
tagious principle probably emanates from the skin, and 
may adhere to furniture or to clothing, and be carried by 
another person from the sick to the well. One attack 
does not protect in the slightest from others. The dis- 
ease begins with fever, languor or restlessness, delirium 
or stupor, and pain in the part involved. These symp- 
toms are often preceded by a convulsion or, in older 
children, a chill. The eruption appears in a few hours. 
The skin of some part of the body becomes shiny and as 
evenly bright red as though red ink had been spilled on 
it. The color disappears upon pressure, but returns 



THE SICK BABY. 307 

rapidly. Sometimes small blisters form. The tissues 
beneath the surface become much swollen. The inflam- 
mation, pain, and fever continue for two or three days, 
and after four or five days the attack is over, at least in 
the original area. Unfortunately, the eruption tends to 
spread in different directions, and the disease may thus 
last indefinitely. Desquamation in small or large scales 
occurs. 

Erysipelas is usually very fatal in children one or two 
weeks old, and severe at all times in infancy. A child 
sick with it should be separated, especially from any one 
who has even a slight abrasion of the skin. A new-born 
baby with the disease must be at once removed from its 
mother for the sake of the latter, for erysipelas in a woman 
after confinement is very dangerous. Quarantine should 
certainly last as long as there is any scaling. Probably 
two weeks from the onset of the disease would be an 
average figure for cases in which the eruption had not 
spread from the original spot. 

Diphtheria. — A very common, contagious, and danger- 
ous disease, attacking any age, although rare in early 
infancy, and most frequent in damp and cold weather. 
The contagious principle is contained in the breath, and 
still more in the saliva and in the membrane from the 
throat or nose. It may stick to clothing or other objects, 
retain its poisonous properties for months, and be carried 
from the sick to the well. The inhalation of sewer-gas 
has often been supposed to cause the disease. While this 
is not certainly true, it is possible that the constant 
breathing of this gas or the living under any other un- 
favorable hygienic conditions makes the disease much 
more likely to occur. One attack in no way protects 
from subsequent ones. The disease begins with fever- 



308 THE CARE OF THE BABY. 

ishness, loss of appetite, debility, heaviness, and sore 
throat. Examination of the throat at this stage may 
show the tonsils swollen and, perhaps, exhibiting a few 
dotted white points as in ordinary tonsillitis, but nothing 
characteristic. In a few hours or by the next day there 
has developed, except in the mildest cases, a white 
opaque membrane covering one or both tonsils and ex- 
tending to other parts of the throat. The child con- 
tinues feeble and feverish; the membrane spreads; the 
glands below the jaw on each side are generally swollen; 
and there is apt to be a running from the nose, due to 
the extension of the disease to it. In average cases 
which recover the patches begin to disappear after a 
week, and are entirely gone after ten to fourteen days. 
The symptoms meanwhile have slowly ceased, except 
the very decided and characteristic weakness, which per- 
sists for a long time. In unfavorable cases the membrane 
continues to form and the child finally dies of exhaustion. 
The membrane very often spreads to the larynx and 
produces laryngeal diphtheria — that is, membranoics croup. 
This very dangerous condition is apt to come on between 
the third and sixth days of the disease. Sometimes, 
however, the membrane attacks the larynx first or solely. 
Nearly every case of membranous croup is in reality laryn- 
geal diphtheria. Although there are occasional instances 
in which the membrane in the larynx is not diphthe- 
ritic, the diagnosis of such an occurrence cannot ordina- 
rily be made with certainty. The first symptom of mem- 
branous croup is hoarseness, which is soon followed by 
rapid and noisy breathing and the peculiar croupy cough. 
Unlike spasmodic croup, the obstruction to breathing is 
persistent. The child sits up in bed laboring for breath, 
looks pale and bluish, and will die painfully of suflfoca- 
tion in a few hours or days if relief cannot be had. 



THE SICK BABY. 309 

The danger of paralysis following diphtheria has 
already been alluded to (p. 270). It is most apt to come 
on during convalescence, between the third and fifth 
weeks. 

With regard to the treatment of diphtheria, any child 
who shows even a small whitish spot in the throat 
should be isolated promptly and be visited by the family 
physician. It may be nothing of consequence, but it 
may be the beginning of diphtheria, and isolation may 
keep the disease from spreading to others. Should the 
physician order applications to the throat, his instruc- 
tions must be carried out implicitly, no matter how cruel 
they seem. Whoever paints the throat must take par- 
ticular care that none of the membrane is coughed into his 
or her nose, eyes, or mouth. The remarkable reduction 
of strength which attends and follows the disease must 
never be forgotten. Death from sudden heart failure 
has not unfrequently occurred after all symptoms had 
disappeared. Consequently, no child suffering from or 
convalescent from diphtheria should be allowed to get 
out of bed, or even to sit up of itself, until the physi- 
cian in charge permits; and if it must be taken up, it 
should be lifted very slowly and carefully. All the pre- 
cautions for isolation and disinfection must be followed 
exactly. All cloths used for the reception of membrane 
or of saliva should be burned at once. If there is any 
difficulty in breathing caused by diphtheria of the larynx, 
the air of the room may be moistened, as well as disin- 
fected, by a disinfectant vapor (Appendix, 98). Quaran- 
tine should continue for at least a week after all trace of 
membrane and redness has left the throat and the run- 
ning from the nose has stopped; or, still better, until the 
physician can find no more germs in the throat or nose. 
In cases of laryngeal diphtheria parents should not hesi- 



310 THE CARE OF THE BABY. 

tate to give permission for any operation which the physi- 
cian in charge may advise. Prompt consent may mean 
the saving of life, and certainly often gives temporary 
relief at the least. 

Whooping-cough ; Pertussis. — A ver}^ frequent and 
exceedingly contagious disease of children; oftenest seen 
under the age of five years, but less so under six months, 
and equally common at all seasons of the year. It is more 
serious than is ordinarily supposed, and a great number 
of children die from its effects, usually as the result of 
some complication, especially pneumonia, tuberculosis, 
convulsions, or catarrh of the bowels. The contagious 
principle seems to reside in the expectoration and the 
breath, and probably is active during the whole attack, 
but usually requires close contact to communicate it. The 
carrying of the contagion by a third person is certainly 
very unusual. A second attack occurs with even greater 
rarity than is the case in measles and scarlatina. The 
disease may be severe, or so light that the child is 
hardly incommoded by it. The younger the child the 
more dangerous is the disease likely to be. The attack 
begins with slight cold in the head and a troublesome 
cough which is worse at night and not relieved by the 
ordinary treatment for bronchitis. In a very few days 
the cough occurs in longer paroxysms, during which the 
child is red in the face and seems hardly able to get its 
breath, and after which it may vomit. After this stage 
of invasion^ which averages two weeks, but which may 
last for only a few days, the whooping or paroxysmal 
j/^^^ begins. The paroxysms, or "kinks" as they are 
often called, are now longer and more intense. The child 
gives a long series of rapidly-repeated short coughs with- 
out drawing breath, and continues this until it is nearly 



THE SICK BABY, 3II 

blue. At last it makes a long-drawn inspiration with 
a peculiar loud crowing sound — the well-known whoop. 
Very often the whole process is repeated immediately, and 
perhaps again and again. The paroxysms are frequently 
so severe that they are followed by vomiting, and the 
child may lose flesh and strength from its inability to 
retain food. A large amount of stringy mucus flows 
from the mouth after the attacks, and may be accom- 
panied by blood. The paroxysms are most frequent at 
night. In a mild case there are only five or six in 
twenty-four hours, but in a severe one there are forty or 
fifty or more. In the mildest cases it sometimes happens 
that no whooping occurs at any time; still, the peculiar 
paroxysmal character of the cough often makes the 
nature of the disease plain. 

The intensity of the attack remains the same for about 
three weeks in cases of average severity, and then the 
stage of decline begins. The paroxysms become less fre- 
quent and the cough much looser, and little by little the 
whooping disappears, until it ceases by six or eight weeks 
from the first onset of cough, and only a bronchitis is 
left, which lasts an indefinite time. When the attack 
occurs in the autumn the bronchitis is very obstinate, 
and may continue with occasional whooping throughout 
the winter. 

Just how long the disease is contagious is uncertain. 
We are safe in saying that it averages six or eight weeks 
from the beginning of the attack. It probably grows 
less contagious as time passes. If the whoop has once 
distinctly stopped and there has been a period of some 
days without it, we may call the disease over, even 
although the whooping should begin again later. The 
second whooping is a sort of habit left by the disease, and 
children have been known to do it even a year after the 



312 THE CARE OF THE BABY. 

attack was over. It cannot properly be considered a part 
of the infectious disease. 

Treatment should be ordered by a physician in every 
case, not only on account of the discomfort which 
attends the attack, but also because of the danger of 
complications. Although the disease can only occasion- 
ally be cut short, it can usually be relieved very de- 
cidedly. If one plan of treatment does not answer, 
another probably will. The child should have an abun- 
dance of fresh air, be warmly clad, and not be exposed 
to draughts. Sleeping in a room which has been well 
aired and not occupied all day will often prevent many 
paroxysms at night. During the paroxysm the child's 
head should be supported by the hand. In very bad 
cases, in which the child becomes almost or quite uncon- 
scious and ceases to breathe, it should be slapped in the 
face with a cold wet towel. Fortunately, these cases are 
not very common. Later in the disease a change of air 
will sometimes do wonders. 

Mumps. — A painful but not dangerous inflammation of 
the salivary glands, which are situated in front of, below, 
and behind the ears and below the jaw. It is commonest 
in the cold season, and seldom attacks very young infants. 
It is distinctly contagious, even during incubation, prob- 
ably by inhaling the breath, since close contact is required. 
One attack usually protects from subsequent ones. The 
disease begins with dulness, more or less fever, and pain 
and stiffness about the jaws, usually on one side. A 
swelling, situated below and slightly behind the ear, 
rapidly develops, and becomes ver}^ marked within forty- 
eight hours. There is much tenderness on pressure, 
chewing is often impossible, talking and swallowing 
are difficult, and sometimes the mouth can scarcely 



THE SICK BABY. 



313 



be opened. After a day or two the other side of. the face 
generally becomes affected in the same way. The whole 
attack lasts about a week. Treatment consists in rest in 
bed and the administration of a laxative and a fever mix- 
ture (Appendix, 103). Food should be soft. A wad of 
cotton covered on the outside with oil silk may be fast- 
ened over the inflamed region. Hot fomentations or 
poultices may be applied if the pain is very great. Quite 
rarely the disease becomes dangerous from complications. 

(6) MISCELLANEOUS DISORDERS AND HABITS. 

Premature Birth. — A child may be born in the seventh 
or eighth month of pregnancy, or even earlier, long be- 
fore it is quite ready to live outside of the mother's body, 
and when it weighs not more, perhaps, than two and a 




Fig. 58. — Couveuse. 

half or three pounds. We need not necessarily despair 
of the life of a baby, however unpromising it seems at 
first. Children born at six and a half months have 
grown up strong at last, although it is not often they sur- 



314 '^^HE CARE OF THE BABY, 

vive if born before the seventb month. The great need of 
such a baby is heat, and the maternity hospitals employ 
an apparatus, called a couveuse^ brooder^ or incubator^ espe- 
cially devised to supply it (Fig. 58). For family use a 
couveuse maybe bought at the instrument-makers, or hired 
from some of them. This is perhaps better, as the apparatus 
is costly. But with an increased degree of attention it may 
be done without entirely fairly well. If a premature baby 
is bathed at all immediatel}^ after birth, the temperature of 
the water should be 102° F., and the greatest care should 
be taken while drying to see that the child is not chilled. 
It should be made very warm by swaddling it in raw cot- 
ton, head and all, leaving only the face exposed, wrapping 
it about with a blanket, and tying it around with a roller 
bandage. Hot bottles should be placed on each side of 
it as it lies thus wrapped up in the bed, and fresh ones 
be substituted frequently. A very convenient method is 
to place the child in a baby's bath-tub half full of raw 
cotton in which numerous hot bottles have been concealed. 
The child's only clothing consists of a diaper and a shirt. 
The room should be kept warm, and especially so when 
this human bundle is unwrapped for its bath. After 
bathing it should be rubbed with sweet oil and be rolled 
up again in fresh cotton. Often it is better to omit all 
bathing, and simply to rub with the oil. Nourishment 
must be given every hour in small quantities. If the 
child is too weak to suck, as is usually the case, it should 
be fed from a spoon or a medicine-dropper. Sometimes 
it is necessar}^ to nourish it through a long elastic tube 
passed through the mouth into the stomach. 

Rickets. — A disease characterized by impairment of 
the general health, but especially by imperfect develop- 
ment of the bones. It is commonest between the ages of 



THE SICK BABY. 315 

six months and three years. Among the causes are in- 
sufficient clothing, damp or ill-ventilated dwellings, a 
lack of outdoor air, and inherited weakness of constitu- 
tion; but the chief cause is some defect in the character 
of the food. Babies fed on healthy breast-milk are not 
liable to develop rickets, but we must be sure that the 
milk is actually healthy. Thus, for instance, too long 
deferring of weaning may cause the disease by rendering 
the milk of insufficient strength. Babies fed on con- 
densed milk are exceedingly prone to develop it, however 
well the food has seemed to agree. Children are very 
likely to become rickety who have constantly suffered 
from disturbances of the stomach and bowels, the result 
of food which contains too much of the casein of milk, 
or in which there is starch or anything else indigestible. 
The first symptoms in well-marked cases are free per- 
spiration about the head while the child is asleep, restless- 
ness, tossing off of the bed-clothes, distention of the abdo- 
men with gas, and sometimes a disposition to cry when 
picked up, the last being due to tenderness about the 
ribs. These early symptoms are very important, inas- 
much as prompt treatment may arrest the disease before 
it advances further. A little later there will be decided 
enlargement of the joints, especially of the wrists and of • 
the junctions of the ribs with the cartilages in front. 
The latter produces a row of little prominences running 
from above downward outside the nipple on each side of 
the chest. This is often called the "rickety rosary," 
from its resemblance to a string of large beads. It can 
be felt, and in severe cases seen as well. The head is 
enlarged and square, with a projecting forehead and flat 
sides and top (PL III., Fig. 3). The fontanelle remains 
open, and by the age of a year may be even larger than 
at birth. The teeth are late in appearing, and there may 



3l6 THE CARE OF THE BABY. 

be none at the age of one year. They often decay very 
early. The muscles are weak and the bones soft, and as 
a result deformities develop. Bow-legs or knock-knees 
often develop, and the chest acquires in its trans- 
verse circumference a peculiar violin-shape with the 
smaller end in front, a groove on each side running 
longitudinally from top to bottom, and a decided promi- 
nence of the breast-bone. With this is combined very 
often a marked enlargement of the abdomen. Lateral 
curvature of the spine in young children is usually due 
to rickets. The long posterior curvature has already 
been alluded to (p. 282). The accompanying illustration 
(PL V.) shows the enlarged abdomen and wrists, and to 
some extent the narrowing of the chest. 

Children with rickets are often fat, and we should there- 
fore have no false sense of security because there has 
been no loss of weight. They are also peculiarly liable 
to suffer from colds in the chest, convulsions, and catarrh 
of the bowels. 

The principal treatment of rickets is preventive. 
Plenty of the best nourishment, a life largely in the open 
air and sunlight, daily immersion in the bath, and prompt 
attention to any disturbance of the stomach and bowels 
will usually avoid any danger. If symptoms appear, there 
is something hygienically wrong, which must be searched 
out. The food must be made even more nutritious, yet 
digestible. Raw-beef juice is often useful. A change 
of air, especially to the sea-shore, may do much toward 
the recovering of the lost health. Cod-liver oil and daily 
salt baths (Appendix, 45) are the best remedies. All 
attempts of the child to stand should be discouraged, as 
bending of the legs is liable to follow. It is hardly neces- 
sary to say that the treatment of a disease as serious as 
this must be guided by a physician. 



THE SICK BABY. 31/ 

Scrofula. — The term scrofula is an antiquated one 
which is mentioned here merely to condemn it. There 
is no such disease as scrofula. Most of the different ail- 
ments once called by this name are in reality only mani- 
festations of tuberculosis in different parts of the body. 
It is a mistake to call the delicate, flabby children with 
enlarged glands and sore eyes ' ' scrofulous. ' ' Some of 
them are tubercular, some syphilitic, and some owe their 
ailments to other causes. The term, if used at all, should 
be applied only to children who have a tendency, per- 
haps inherited, to develop tubercular affections; but even 
this use is questionable, and, owing to the confusion 
which exists about the proper employment of the word, 
it is better to abandon it altogether. 

Rheumatism. — This disease may show itself as a severe 
acute inflammation of many of the joints of the body, with 
high fever and extreme pain on the slightest movement; 
as a slighter and more chronic inflammation of only one 
or a few joints, which become more or less red, tender, 
and swollen; as a stiffness and soreness of some of the 
muscles; or, finally, in some other more unusual way, as 
in the heart or the nervous system. It is much more fre- 
quent in children than is commonly supposed. The fact 
that an infant cries out when some part is moved, or that 
it is unwilling to use an arm or a leg as freely as ordi- 
narily, should render one suspicious that rheumatism is 
present. The mildest form of articular rheumatism may 
be followed by St. Vitus' dance or by heart disease. The 
latter is more liable to follow rheumatism in children 
than in adults. It is, indeed, at times the first and the 
only symptom of the rheumatic state, and there may be 
no articular or muscular pain at all. In older children 
the pains in the joints, which are often called "growing 
pains ' ' or are attributed to sprains, and looked upon as 



3l8 THE CARE OF THE BABY. 

matters of no consequence, may really be due to rheuma- 
tism or to hip-joint disease. The diagnosis is so import- 
ant that medical advice is recommended in all doubtful 
cases, and certainly in those which are clearly rheumatic. 
A child with even a slight attack of joint rheumatism 
is better kept at rest in bed, in order to ward oflf a rheu- 
matic inflammation of the heart by throwing as little 
work on that organ as possible. The food should be 
light and easily digestible, and meat should be avoided to 
a great extent or entirely. All exposure to chill must be 
prevented, and the inflamed parts should be wrapped in 
cotton-wool or flannel. 

Enlarged Glands. — The glands in the neck or else- 
where may enlarge, and can then be felt as larger or 
smaller movable and somewhat tender lumps below^ the 
skin. If the inflammation in them is intense, they grow 
larger still, become red and soft and filled with pus, and 
finally burst. When they show a tendenc}^ to persist, 
to increase in size and number, and, it may be, slowly to 
suppurate one after another, the suspicion arises that tu- 
berculosis is the cause. The suddenly-developing inflam- 
mations are generally due to an acute irritation some- 
where. For instance, enlargement of the glands below 
the jaw is often the result of inflammation in the mouth, 
and occurs in diphtheria and scarlatina because the mouth 
and throat are affected. Enlarged glands at the back of 
the neck follow irritation of the scalp by eczema or other 
cause; those below and behind the ear result from irrita- 
tion of the ears or swelling of the tonsils, or frequently 
accompany measles and German measles; those in the 
armpit may be the result of some sore upon the hand, 
chest, or arm; and those in the groin may follow^ a similar 
condition of the low^er extremity. Usually the sw^ellings 



THE SICK BAB V. 3 1 9 

disappear very soon after the cause is removed. The dis- 
appearance may be aided by rubbing them gently twice a 
day with soap liniment. Sometimes, however, the swell- 
ing is very obstinate, or may go on rapidly to form an ab- 
scess. As a rule, only one gland is involved in such 
cases. In any case where the swelling does not disap- 
pear promptly a physician should be consulted, as the 
trouble may be of a serious nature. 

Marasmus. — This term, so commonly used, does not 
indicate any distinct disease, but rather a progressive 
wasting or *' fading away" of the body. The child be- 
comes excessively thin, is pale and often sallow, its face is 
wrinkled, and its flesh hangs on its bones. Among the 
causes are tuberculosis, syphilis, chronic vomiting, per- 
sistent although slight diarrhoea, and food which is in- 
adequate in quality or quantity. In nearly every case a 
physician can discover the cause, and often can remedy it. 

Inflammation of the Breasts. — In both boy and girl 
babies a day or two old the breasts are very apt to swell, 
to become tender, and to secrete a milk-like fluid. If 
they are let alone or are rubbed gently with warm oil or 
vaseline, the trouble disappears in one or two weeks. If 
the swelling is very decided and the breasts are red, wet 
dressings will be of service, but the physician in attend- 
ance must take charge in such cases. Some ignorant 
nurses have the habit of squeezing the breasts of new- 
born children in order to empty them w^ell or, in the case 
of girl babies, to favor a good development later in life. 
Such a procedure is unnecessary and harmful in the ex- 
treme, and may even produce an abscess. 

Hiccough. — Although seldom of any serious impor- 



320 THE CARE OF THE BABY. 

tance, this may be very annoying. It consists of a spas- 
modic contraction of the diaphragm. It is usually 
dependent upon some disturbance of digestion, but may 
be due to many other causes. In babies it may often be 
relieved by a rapid change of position, patting the back, 
or by giving a little hot water, perhaps with soda mint 
(Appendix, loo). In the case of older children the 
drinking of a glass of water, the holding the breath as 
long as possible, or causing the child to laugh is often 
effective. 

Fever. — Fever is, of course, only a symptom of a 
large number of affections. As it often develops sud- 
denly and without other symptoms, a mother should 
know some simple plan of treatment which may do good 
and cannot work harm, and which she may employ before 
the physician arrives. First of all, the clinical thermom- 
eter should always be used (see p. 43) to determine 
whether or not there really is fever. A moist skin and 
cool hands are not always a sign of the absence of fever, 
any more than hot head or hands are a positive sign of 
its presence. A feverish child has usually little appetite 
or power of digestion, and food should be withheld or 
be of the lightest kind. Milk is the best thing under 
most circumstances, or some such article as milk-toast, 
junket, arrowroot, or light broth. If food is vomited, 
the child should have no nourishment at all. A good 
laxative, such as a full dose of magnesia or castor oil, is 
always admissible, and a fever mixture (Appendix, 103) 
may be given. Confinement to bed is desirable. Other 
children should be kept away, both for the sake of 
quiet and to avoid danger of contagion should an infec- 
tious disease be beginning. A warm mustard bath (Ap- 
pendix, 38, 42) is often given to "bring out the rash" 



THE SICK BABY. 321 

if it is an eruptive fever starting. If fever persists and 
no perspiration has occurred four or %m^ hours after the 
bath, the extra wrappings may be removed and the 
coverings made as light as is comfortable to the patient. 
The abnormal heat of the skin makes the thickness of 
covering required less than in health. The child may 
have water to drink, cool but not iced, freely in any 
reasonable quantity. Mothers err greatly in refusing to 
give a thirsty child water. Bathing of the head with 
bay rum is always permissible if it does not produce 
chilliness. A cold wet cloth may be laid on the head if 
headache is severe. 

Dropsy. — An accumulation of fluid in any part of the 
body. The condition may be limited to one part, or 
may be general and affect the whole surface of the body. 
The most frequent causes are disease of the heart and 
Bright's disease. In the last stages of chronic debilitat- 
ing diseases, such as consumption, dropsy of the feet and 
hands shows that the end is approaching. Peritonitis 
and disease of the liver produce dropsy of the abdomen. 
Treatment can be conducted only by a physician. 

Cold Hands and Feet. — This condition is usually a 
sign of imperfect circulation, itself depending upon in- 
digestion, general poor health, insufficient clothing, 
lack of exercise, and similar causes. It not infrequently 
develops shortly after the baby begins to wear stockings 
and shoes, before it has became accustomed to them. 
The stockings should be warm and loose, and the shoes 
large. The warmth of the clothing of the whole body 
ought to be increased, and all other possible causes re- 
moved. Sponging the hands and feet with cold water 
and following this by brisk friction is often a valuable 

21 



322 777^ CARE OF THE BABY. 

plan, or they may be rubbed daily with turpentine, per- 
haps mixed with an equal part of sweet oil. As children 
cannot sleep well if the hands and feet are cold at night, 
a hot-water bottle or bag must be placed in the bed if 
other plans do not suffice. 

Retention of Urine. — No urine may be passed for 
twenty-four or even more hours after birth, and yet 
nothing serious be amiss. If a warm bath or a poultice 
over the bladder does not relieve the difficulty, the 
advice of a physician ought to be asked promptly, as 
there may be some physical obstruction. Sometimes the 
pain which passing water causes induces a child to retain 
the urine as long as possible. Sometimes, too, after a 
severe attack of colic a child is unable to pass water for 
perhaps twelve hours, and suffers considerable pain as a 
result, as shown by the straining cry and the frequent 
doubling of the legs upon the abdomen. A bath or a 
poultice will probably produce a passage of urine. There 
is apt to be but little urine passed at the beginning of 
fever or during severe diarrhoea. Such a condition is a 
matter of no consequence, so far, at least, as the urinary 
symptoms are concerned. In acute Bright' s disease the 
urine is often smoky or muddy (brownish, not reddish) 
in appearance and very scanty. This condition is a very 
serious one. It is more apt to develop during or after 
scarlet fever. A hot poultice should be applied over the 
kidneys — that is, just below the last ribs on each side of 
the spine — and a doctor must be summoned at once. 

Bed-wetting; Incontinence of Urine. — The habit of 
wetting the bed at night or the clothes by day is a dis- 
ease^ and not a bad habit merely, and it is an unwar- 
rantable cruelty to punish a child for it. There are cases 



THE SICK BABY. 323 

in which threats or punishment may avail, but these are 
so rare that they may be ignored for all practical pur- 
poses. The causes are various, and the advice of a 
physician is always required, for the matter is sometimes 
serious and is always annoying. The only treatment 
open to the mother is to see that the child has a light 
supper, is made to pass its water just before going to bed, 
drinks no fluids for some hours before bedtime, is taken 
up frequently during the night to empty its bladder, 
sleeps on the side and not on the back, and is not too 
warmly covered. To prevent sleeping on the back an 
empty spool may be tied at the middle of the spine by 
a tape going around the waist. 

Pain in Passing Urine. — It may happen that a baby 
in apparently perfect health often suddenly begins to cry 
bitterly without any discoverable cause, continues this 
for a short time, and then ceases. There are no other 
s}inptoms, but further study shows that the crying 
occurs only when the urine is passed. The natural con- 
clusion is that the passage is painful, and an examina- 
tion of the parts should be made. If nothing can be 
found, it is probable that the urine is unusually irri- 
tating. In such cases an examination of the diaper may 
show a reddish or yellowish deposit which, when dry, 
can be rubbed between the fingers, and which feels like 
the very finest gravel — as, indeed, it is. 

Piiimosis. — This term denotes the existence of a long 
and very narrow fore-skin in boy babies, which cannot 
be retracted so as to expose completely the parts beneath. 
It always demands examination by a physician, since the 
retention of the cheesy secretion beneath it is liable to 
make trouble if the condition is neglected. Sometimes 



324 THE CARE OF THE BABY. 

circumcision is required, but oftener less radical treat- 
ment is sufficient. 

Leucorrhoea. — A leucorrhcea which maybe quite pro- 
fuse is not at all of infrequent occurrence in little girls 
even in infancy. The knowledge of this fact may save 
a great deal of unnecessary anxiety. The disease some- 
times comes from direct injur>^ received, for instance, 
from a fall on a sharp object, or in other ways, but much 
oftener is the evidence of debility. It is occasionally 
produced by thread-worms which have found their way 
into the passage from the bowel. Treatment consists in 
great cleanliness, washing with and injecting of a solu- 
tion of boric acid (Appendix, 75), and, in case there is a 
great deal of external irritation, the application of a boric- 
acid-and-zinc ointment (Appendix, 71) upon a piece of 
lint folded and laid between the irritated surfaces. In 
any obstinate case — and the disease is very apt to prove 
so — a physician must be consulted. 

The Blue Baby ; Congenital Cyanosis. — It some- 
times happens that a new-born baby has a bluish tinge, 
showing that the blood does not circulate properly or get 
enough oxygen. This is not infrequent in the first days 
of life, and is then a matter of no consequence if the 
child is otherwise well. Should, however, the color per- 
sist, the heart is probably diseased. In mild cases the 
blue tinge appears only when the baby cries, but if the 
disease is severe the color is constant and death will 
probably take place in a few days or months. In those 
who live to older childhood, or even to grow up, there 
is apt to be shortness of breath, palpitation, and a tend- 
ency to the bluish tinge either constantly present or com- 
ing on with exertion or with any slight cold in the chest. 



THE SICK BABY. 325 

Snoring ; Mouth-breathing. — These symptoms may be 
due to overgrown tonsillar tissue, as already mentioned, 
or to obstruction to breathing through the nose from 
some other cause. An examination of the throat and 
nose should be made by a physician in every case, since 
it is important to remedy the difficulty as soon as possi- 
ble. Children who have long been mouth-breathers from 
nasal obstruction often acquire a characteristic expres- 
sion of face and an impairment of bodily and mental 
development (Chap. XL, p. 249). Snoring in infancy is 
not often merely a habit; but should examination show 
clearly that it is so, the infant's mouth may be gently 
closed whenever it is found open during sleep. A band- 
age may be placed under the chin and over the top of 
the head, and this will serve the purpose even better. 

Thumb-sucl<ing. — A great deal has been written about 
the dangers of thumb-sucking, yet the habit is an ex- 
ceedingly frequent one, and few children seem to have 
suffered from it in the slightest degree. As there never 
is any advantage in the practice, it is best not to let it 
begin, and certainly not to allow it to advance. In the 
case of babies who have already contracted it, but who 
suck their thumbs only if not well or if cutting a tooth, 
or as a means of quieting the nervous system when they 
want to go to sleep, there is no cause for worry. The 
habit will correct itself in good time, or, if not, can be 
easily broken up. In some cases, however, the habit 
begins during the early weeks of life, soon becomes in- 
veterate, and may persist for years or even into adult 
life, the child sucking its thumb nearly continuously, 
whether awake or asleep. A condition such as this 
demands active treatment, since there is danger of the 
jaw being permanently deformed. 



326 THE CARE OF THE BABY. 

The commonest deformity resulting is the V-shaped 
jaw, in which the middle of the upper jaw is pried for- 
ward by the pressure of the thumb against its edge, so 
that it assumes a too angular shape. The lower jaw is 
depressed, and the upper teeth grow forward like those 
of a rabbit, and sometimes even the nose is distorted by 
the upward pressure of the thumb upon the palate. 

If it is noticed that the habit is being formed, the 
thumb should be gently removed from the mouth when- 
ever found in it, and the child's attention directed to some- 
thing else. If the habit has already been contracted, yet 
is not practised immoderately, it is questionable whether 
it is worth while to bother about it unless it tends to 
persist. If treatment is required, as in the persistent 
thumb-sucking described, bitter or disagreeable-tasting 
substances, such as infusion of quassia, extract of aloes, 
or asafoetida, may be put upon the thumbs. This is of 
no avail in bad cases, and the only method to be depended 
upon is that of forcibly keeping the thumbs out of the 
mouth. This may be done by making the sleeves of the 
night-dress extend considerably below the hands; or the 
child may have its hands put into little flannel bags or 
fastened to its sides at night — and during the day, too, if 
necessary. Persistence in this treatment for months is 
sometimes required. 

Biting the Finger-nails. — This is a common habit in 
children of two years and older, and one which often 
persists into adult life and ruins the shape of the fingers. 
It is generally merely the expression of an innate ner- 
vousness. Many children bite their nails only when 
excited, while others — the most inveterate cases — do it 
even when asleep. In its treatment the effort must be 
made to relieve the nervous excitability by suitable 



THE SICK BABY. 327 

hygienic measures, although this is often a difficult mat- 
ter. The habit may sometimes be broken up by dipping 
the fingers into a solution of some bitter substance, or, 
when this fails, by forcibly keeping them from the mouth, 
as in the case of thumb-sucking. 

Defective Speech (Stammering, Stuttering, Lisp- 
ing. — The terms stainmeriiig and siititen'jig sat generally 
used interchangeably, although they are not identical in 
meaning. Stammering applies to the affection of speech 
in which the child is scarcely able to pronounce words 
at all. Shittej'iiig is that in which the child makes 
sounds which it does not wish to make, such as the rapid 
repetition of a consonant at the beginning of a word, as 
*'p-p-p-p-pig." For our purposes we may consider both 
affections under the title of stammernig^ and much that 
will be said applies to lisping as well. The habit is 
really a nervous disease, and might have been classified 
accordingly. It is not common before the age of six 
years, although occasionally seen earlier, is more frequent 
in boys than in girls, and is sometimes hereditary. The 
most important treatment is preventive, but the same 
methods apply to those who already have the habit. A 
child should be made from the beginning to talk slowly 
and deliberately and to pronounce all words ver}' dis- 
tinctly. In this way it will never find any words espe- 
cially difficult. It must be carefully kept from associa- 
tion with stammering teachers, schoolmates, or friends, 
since its power of imitation is so remarkable. It must be 
maintained in the best of health, avoid nervous excite- 
ment, and never be allowed to talk when in a hurry. If 
there is the slightest tendency to stammer, the import- 
ance of slow and exact speech is all the greater. Scold- 
ing for the defect, or notice taken in a way to embarrass 



328 THE CARE OF THE BABY. 

the child, will only make the trouble more pronounced. 
Exercises in breathing are very important, since the dis- 
ease seems to depend in part on lack of control over res- 
piration. The taking of deep breaths, holding them for 
a few seconds, and then letting them out slowly or with 
interruptions is very useful. This process may be re- 
peated several times a day. A stammering child should 
take a full breath before beginning a sentence, and should 
have training of the voice systematically carried on. It 
should be practised in uttering the vowel sounds slowly 
and without hesitation, first in a whisper and then out 
loud, since the whispered voice is not apt to be stam- 
mered. The sounds may then be preceded by consonants. 
A single forcible expiration should be used to pronounce 
each syllable. The use of rhythm is a very great help. 
Stammering is little likely to occur when syllables, words, 
and then sentences are pronounced in the slow, rhythmi- 
cal way which one sometimes hears in schools when 
children recite in concert. Stammerers usually can sing 
without difficulty. Should a child begin a sentence im- 
properly, it must invariably be made to stop at once and 
to repeat it slowly. This necessitates constant watchful- 
ness, perseverance, and patience on the part of the 
mother, for recovery will probably be slow. There are 
institutions for the cure of stammering, and children 
who do not improve at home should be sent to some 
good one of this sort. 

Holding the Breath. — This, like the preceding, is a 
nervous disease even more than a habit. After a parox- 
ysm of crying, which is often the result of anger, a child 
may suddenly stop breathing until, in severe cases, it 
grows blue in the face and is nearly unconscious. A 
crowing inspiration sometimes attends the return of 



THE SICK BABY. 529 

breathing. The afifection is the result of a sudden spas- 
modic closing of the larynx dependent upon the great 
nervous excitement. It is generally not at all a serious 
matter, although in rare cases it may pass into general 
convulsions or terminate in death from suffocation. If 
the attacks are of frequent occurrence or severe, we 
should suspect that the child has rickets. Sudden slap- 
ping of the face with a cold wet towel or the dashing of 
cold water into it from a glass is the best immediate 
treatment. The shock of this procedure makes breath- 
ing recommence. Medicines which are sedative to the 
nervous system may be needed. 

Masturbation ; Self-abuse. — The habit may be begun 
by small children, or even by infants, both boys and girls. 
Sometimes some local irritation is at fault, such as phimo- 
sis, worms in the bowel, inflammation of the vagina, and 
similar causes. In infants constant supervision must be 
given, the hands being forcibly restrained if need be. In 
older children the habit is sometimes the result of the in- 
fluence of evil companions. In these cases remonstrance 
and judicious explanation may avail, and especially the 
constant but entirely unobtrusive watching of the child, 
who should be kept as much as possible in the company 
of the mother or nurse, and observed particularly while in 
bed, at the water-closet, or in other places where usually 
left alone. Great judgment is required to choose when to 
ignore and when to remonstrate. IMedical advice should 
be had in bad cases, and an examination for local causes 
made. 

(7) ACCIDENTS AND EMERGENCIES. 

Cuts and Tears. — A cut^ or incised woiuid^ is made by 
some sharp cutting instrument. If deep or extensive, or 



330 THE CARE OF THE BABY. 

if bleeding very freely, it should have surgical attention 
at once. A small cut which can be dressed at home 
should be washed gently but thoroughly with absorbent 
cotton and cold or very hot water (which will both 
cleanse it and help to arrest the bleeding) and then with 
an antiseptic solution, such as a carbolic-acid lotion 
(Appendix, 76) or, still better, one of corrosive sublimate 
(Appendix, ']^). A compress made of clean folded linen or 
muslin wet with the solution should now be placed over 
the wound and bound on, not too tightly, with a roller 
bandage. The dressing may be left on unchanged for 




Fig. 59. — Roller bandage, showing the method of making the " reverses," 

days if it keeps perfectly sweet-smelling and the child is 
not feverish or in pain. The illustration (Fig. 59) shows 
the different steps in the application of a roller bandage. 
The half turn in the bandage, technically known as the 
reverse^ makes the bandage lie smooth and clos^ to the 
limb. 

If the wound secretes pus, the old dressing must be 
soaked in the antiseptic solution until it comes away 
easily and without pulling, the wound then washed with 
the solution, and a fresh dressing applied. This may 
have to be done daily if pus continues to appear. We 
must never forget that both the carbolic-acid and the 
corrosive-sublimate solution are poisonous if swallowed. 
If the bleeding will not stop, the bandage must be 



THE SICK BABY. 33 1 

applied with moderate firmness, or pressure be made with 
a finger, and a surgeon called in. If the blood spurts out 
of the wound in jets, an artery has been injured. Bleed- 
ing from this or from any other wound can always be 
stopped until the doctor arrives by making pressure with 
the fingers directly into the wound. The pressure must 
be constant, and not relaxed every few minutes to see if 
the flow has ceased. The use by others than physicians 
of what is called a touriiiqiict — such, for instance, as a 
twisted handkerchief or a cord tied tightly around the 
arm or the leg — is not only very painful, but is dan- 
gerous also, since it may cause serious injury of the 
tissues. 

Should a child chance to have a finger cut off, this 
should be immediately washed carefully and fastened 
firmly in place again with adhesive plaster, and a physi- 
cian sent for. It sometimes happens that the finger will 
unite. 

A tear^ or lacerated ivound^ is produced by some dull 
body, such as a nail or a brick. It has ragged edges and 
does not often bleed much. Unless very small, a physi- 
cian should treat it, since wounds of this sort are more 
likely to leave scars. A small tear must be cleansed 
carefully with lukewarm water followed by an antiseptic 
solution (Appendix, 75-77), as it is very apt to have 
dirt in it. The torn edges should be brought together as 
well as possible, and the wound covered with a com- 
press wet with the antiseptic fluid and bandaged up 
loosely. The dressing must be renewed every day if it 
becomes soiled with pus, following the method just de- 
scribed for cuts. If it remains unsoiled, it may be left on 
until the wound is nearly healed. The small sore which is 
left may be dressed several times a day with a zinc-and- 
boric-acid ointment (Appendix, 71) spread on a small 



332 THE CARE OF THE BABY. 

piece of lint. This ointment is also very useful for cases 
in which the skin has been partly scraped off — as, for in- 
stance, when the head or the knee has been scraped 
along the ground. 

Punctured Wounds; Splinters. — Punctured wounds 
are those made by sharp-pointed objects, such as pins, 
needles, fish-hooks, tacks, splinters, and the like. They 
are often painful and attended by a good deal of 
swelling. The object must be removed and the injured 
part squeezed gently in warm water in order to favor the 
flow of blood, which will help to wash away the im- 
purities which may have entered. If there is a tendency 
to swelling, a warm antiseptic poultice may be applied 
(Appendix, 62). 

In the case of injury by a needle great care must be 
taken not to break it oflf in the flesh, and the needle 
should be closely examined after removal to see that this 
has not happened. If it has been broken, a surgeon 
must be called in and the fragment saved to show him. 

Fish-hooks which have entered beyond the barb must 
either be cut out or be pushed through the skin from 
inside, but never torn out. 

If any portion of a splinter is protruding, it may be 
seized with small pliers or tweezers and be pulled out, 
care being taken to avoid any side motion, lest the wood 
break ofif. If it cannot be removed in this way, it may, 
perhaps, be picked out with a needle. Should a splinter 
too short to grasp have lodged beneath the finger-nail, 
the nail should be carefully scraped very thin over it and 
then be split open with the point of a sharp knife, just 
enough to allow of the top of the piece of wood being 
seized. This is not as difficult as it sounds, and gener- 
ally causes very little pain. If efibrts to remove a splin- 



THE SICK BABY. ^7^ 

ter fail and a physician cannot be had, the part should be 
poulticed until pus forms, when the splinter will probably 
come out with it. 

Poisoned Wounds. — Insect-stings belong to the class 
called poisoned wounds. They are seldom dangerous, 
although for a time quite painful. Careful examination 
may show the sting of the insect still in the wound. It 
should be pulled out with tweezers, and water of ammo- 
nia or spirits of camphor applied. A cold-water dressing 
may then be employed to prevent swelling. The appli- 
cation of mud is as useful as it is old-fashioned. 

Mosqicito-bites are of this same class. The}- are often 
a source of great annoyance and disfigurement to chil- 
dren. The best procedure is to keep the little pests away 
by having screens fitted to the windows and doors, or a 
large canopy over the bed. A small canopy tends to 
shut out the air too much. The annoying itching may 
be allayed by touching the bites with carbolized oil (Ap- 
pendix, 72), ammonia, or spirits of camphor, or with a 
cooling evaporating lotion (Appendix, 84). Dampened 
salt rubbed on the spot is sometimes useful. 

Dog-bites or the bites of other animals, as the cat or 
rat, are sometimes productive of severe inflammation, 
and even of decided illness. It is rare, however, that 
hydrophobia follows. The dog which has bitten any one 
should on no account be killed until it has been kept 
long enough to determine whether or not it was mad. 
To fiud that the animal was not rabid will be a great 
relief to all concerned. Wounds produced by the bite 
of an animal should be pressed out thoroughly under 
warm water or be well sucked. They may then be 
covered with a cold wet dressing. If the bite is that of 
a dog undoubtedly mad, the part must be cut out quickly 



334 1^^^ CARE OF THE BABY. 

or be cauterized deeply with a red-hot iron or with strong 
carbolic or some mineral acid, such as sulphuric or nitric. 
Snake-bites constitute a variety of poisoned wounds 
fortunately not often met with in this part of the world. 
If the snake was a venomous one, a cord should at once be 
tied around the limb above the wound to stop the prog- 
ress of the blood and to keep the poison out of the 
general circulation. The wound should be squeezed out 
under water, or may be sucked thoroughly, provided the 
lips of the person who does this are quite free from 
cracks. It ought then to be cut out or cauterized as in 
the case of dog-bites. Stimulants in large quantity have 
been recommended, and are perhaps of service. A solu- 
tion of permanganate of potash of the strength of 20 
grains to the ounce should be used to wash the wound. 

Bruises.^ — Bruises, which belong to the class of coii- 
tiised wounds^ generally do little damage other than tem- 
porarily to disfigure. A painful swelling develops, 
rapidly increases in size, and turns deep purple as the 
result of the escape of blood under the skin. This color 
gradually passes through different shades of green and 
yellow until the blood has been absorbed. To prevent 
the swelling and discoloration to any degree the treat- 
ment must be begun at once. Firm pressure may be 
kept up, or compresses wet with ice-water, very hot 
water, or alcohol and water continuously applied. The 
colorless fluid extract of witch hazel put on at once on a 
compress is excellent treatment. Ichthyol is another 
useful application. If discoloration has occurred, its dis- 
appearance may be hastened by rubbing the bruise with 
lanolin. 

Sprains. — A twisting or straining of a joint, or a sprain^ 



THE SICK BABY. 335 

produces great pain on motion, rapid swelling, and 
often a discoloration of the skin like that of a bruise. 
Although in many instances sprains are slight and are 
quite well in a few days, in some severe ones recovery is 
very slow and the bad effects are more lasting than in the 
case of broken bones. Every sprain except the very 
mildest should have a physician's attention as early as 
possible. If this cannot be procured, the joint should be 
soaked in hot water and then be put at absolute rest. If 
it is the ankle or the knee which is injured, the child 
must be kept in bed with the part elevated and covered 
with a dressing of cold water or of witch hazel. In the 
case of the arm the joint must be kept quiet on a pillow 
or supported on a splint or in a sling with the dressing 
applied. After the acute pain and all signs of inflamma- 
tion have disappeared — which is often a matter of days 
or even of weeks — the joint may be rubbed daily with 
soap liniment or chloroform liniment and very carefully 
and slightly moved. Ichthyol is also a good application 
for sprains. 

Fractures and Dislocations. — In dislocations the bones 
which meet at a joint become separated from their nor- 
mal relation — that is, they are "out of place. " Disloca- 
tions are unusual in children, with the exception of that 
of the elbow-joint. In a fracture a bone is broken par- 
tially or entirely in two. Very frequently in children 
there is what is called a " green-stick fracture;" that is, 
there is a bending, not a complete breaking across the 
bone. This is because a child's bones are much less 
brittle than those of an adult. Both fractures and dislo- 
cations are painful, and produce decided deformity at the 
time. The injured child while being carried to the 
house or bed must be handled most carefully, and the 



33^ THE CARE OF THE BABY. 

part, especially if fractured, be always supported, since 
the slightest motion of the rough ends of the broken 
bone gives agonizing pain and tears the flesh about them. 
If the child has to be taken some distance, the limb 
should be bandaged with handkerchiefs or anything else 
at hand to an improvised splint, such as a piece of board 
or pasteboard, several newspapers folded so as to give as 
much stifihess as possible, or even a couple of small 
branches from a tree. In a similar way a broken leg can 
be bandaged to the sound one, or the arm to the side. 

Burns and Scalds. — A burn is the result of contact 
with a flame or with dry heat of some sort, while a scald 
is produced by a hot fluid. For convenience we may 
call them both burns, for the injury to the tissues is the 
same in each except that the damage from hot liquids is 
apt to be less deep. The danger to life from a burn de- 
pends more upon its extent of surface than upon its 
depth. On the other hand, the degree of subsequent de- 
formity depends upon the depth of the injury. If half of 
the surface of the body is involved, the result is nearly 
always fatal. In the more superficial burns the skin is 
reddened and perhaps blistered, while in the deeper ones 
it is yellowish-white or blackened. The pain is usually 
very severe, 3'et in the worst cases the child may suffer 
very little, but be so alarmingly prostrated by the shock 
that it may die in a few hours. Only the small and 
slight burns may be treated by the mother. Pain must 
be first relieved by shutting away the air and preventing 
the rubbing of the clothes. To accomplish this several 
layers of soft linen cloth may be applied, wet with a 
strong solution of baking-soda — a heaping teaspoonful to 
a glass of water. As soon as the pain is allayed, or even 
from the first if not severe, the wound may be dressed 



THE SICK BABY. 337 

with vaseline or oxide-of-zinc ointment; or, often still 
better, carbolic acid and water (Appendix, 76), as this 
makes the wound aseptic. If a child's clothes are on 
fire, its head should be placed low, for the flames 
naturally tend to rise, and burns about the head and 
hands are the most disfiguring. The child should in- 
stantly be thrown upon the floor and the burning clothes 
wrapped about with some thick woollen material, such 
as a piece of carpet, a rug, table-cover, dress-skirt, shawl, 
or overcoat, beginning always at the neck. Cotton and 
linen articles catch fire too easily themselves, but even 
these are better than nothing, for if quickly applied they 
may smother the flames before they are ignited by them. 
Nothing can be better than a tub or bucket of water 
dashed over the child, if this happens to be at hand. 
Running about the room or into the open air with the 
child only fans the fire. After the flames are extin- 
guished stimulants should be given if there is much 
prostration, the child put to bed at once, and the cloth- 
ing removed with the greatest gentleness if a physician 
cannot be had promptly. Frequently the garments must 
be cut away bit by bit in order to avoid tearing the blis- 
ters which have been produced. These blisters may now 
be pierced at the edge with a needle, and the burnt 
parts covered with soft linen cloths saturated with car- 
bolized water (Appendix, 76), sweet oil, vaseline, or lard 
which has been washed free from salt. Lastly, the whole 
should be enveloped in raw cotton, oil silk, or paraffin 
paper, and bandaged loosely in order to exclude the air 
still more perfectly. Hot bottles should be applied to 
portions of the body which have not been burnt if the 
prostration continues. 

Burns with acids should have the liquid washed away 

quickly with water or, still better, with a solution of 
22 



338 THE CARE OF THE BABY. 

baking-soda. Burets with alkalies^ as lye, should be 
treated quickly with vinegar and water. Each sort may 
then be dressed with oily applications, such as olive oil, 
vaseline, or zinc ointment. 

It must be remembered, however, that oily applica- 
tions used on a burn of any kind usually add to the 
difficulty of making it aseptic when the doctor arrives, 
and that an antiseptic dressing, such as the carbolized 
water referred to, is to be preferred. 

Sunburn. — The open-air life so greatly to be desired is 
liable to cause sunburn, which, if of slight extent, is a 
matter of little consequence. To be ruddy from the sun 
is much better than, from lack of fresh air and sunlight, 
to look like a potato-sprout in a dark cellar. Sunburn 
may, however, become so severe that it is actually pain- 
ful and demands treatment. The skin in such a case 
may not only be reddened and tender, but blistered and 
much swollen also. The simplest treatment consists in 
covering the injured parts with oxide-of-zinc ointment. 

Freckles. — Deposits of pigment in the skin in the 
form of irregularly-shaped small blotches, usually result- 
ing from exposure to the sun or glare. They are most 
marked in blondes, especially in those with red hair and 
a very transparent complexion. Brunettes may develop 
them also, but are more likely to have a uniform deposit 
of pigment; that is, they become tanjied. Freckles are 
not common before the age of three years, and the tend- 
ency to develop them often diminishes after the age of 
puberty. Although keeping a little girl out of the sun 
may prevent freckles, it would certainly injure her 
health. The best plan to avoid them is to have the face 
shielded by a broad-brimmed hat and to shun the most 



THE SICK BABY. 339 

intense glare. There are numerous applications recom- 
mended to remove them. Some of these are much too 
powerful to be used except under a physician's direction. 
This is also true of many of those sold in the shops. A 
preparation which may be tried safely is a benzoin or a 
borax-and-acetic-acid mixture (Appendix, 85, 86). 

Frost-bite; Freezing. — The first effect of long ex- 
posure to cold is to make the skin, usually of the fingers, 
toes, nose, or ears, become numb, white, and wrinkled. 
Then, upon coming into a warm place, the parts become 
red, swollen, and itching. If the action of the cold has 
been severe, blisters form over the frozen skin, and finally 
mortification may set in. Generally, under proper treat- 
ment the frozen part regains its sensation and becomes 
painful for a time, the swelling disappears, and there is 
no further trouble. In the case of those who have 
been nearly "frozen to death" the whole body is 
affected by the cold and there is unconsciousness. In the 
treatment of freezing, the child should be kept in a cool 
room for some hours and the frozen parts — or the whole 
body, if it is a case of general freezing — be rubbed with 
cold water or snow or wrapped in cold wet cloths. The 
removal to a warm place should be made with the 
greatest care. Sometimes a frozen part may afterward 
be subject to chilblains. 

Chilblains. — Red, smooth, shining spots of different 
sizes which itch and burn severely when the parts 
become warm. Sometimes blisters form, and even ulcers 
if there is much friction, as from a shoe. The favorite 
positions are the feet and hands, although the nose, 
cheeks, and ears are occasionally attacked. Chilblains 
are particularly painful when upon the feet, after they 



340. THE CARE OF THE BABY. 

have become warm in bed. They are most apt to 
develop in weakly children, especially in girls with poor 
circulation, and are liable to recur every year with the 
autumn season and to last until warm weather returns. 
The original cause consists in sudden alteration of the 
bodily temperature — such, for instance, as follows rapid 
warming of the hands and feet at a fire after prolonged 
exposure to wet or cold. Treatment consists in improv- 
ing the general health and in dressing the feet with 
broad, stout, easy shoes and with warm woollen stock- 
ings with garters going to the waist, or with warm mit- 
tens if the chilblains are on the hands. Frequent paint- 
ing with Mouse? s solution of iron or with tincture of 
iodine is often of great benefit. 

Concussion of the Brain. — A serious disturbance of 
the brain produced by a fall or a blow upon the head, 
and attended by complete or partial loss of consciousness 
lasting for a moment or for hours. The skin is pale and 
cold, and the pulse and respiration are feeble. The child 
may seem merely stunned, and there may be only vomit- 
ing and pallor and a bewildered condition. As even the 
mildest cases sometimes become serious later, every child 
who has exhibited any suspicious symptoms after an 
injury to the head should have medical advice as soon as 
possible. Meanwhile it should be put to bed in a dark- 
ened and very quiet room and be warmed by hot bottles 
if cold, but given no stimulants unless it is absolutely 
necessary. If it has severe pain in the head, but is not 
cold or weak, an ice-bag or ice-water compresses may be 
applied to prevent the development of inflammation. 

Foreign Bodies in the Eye. — A cinder or other minute 
sharp particle often causes great irritation in the eye. If 



THE SICK BABY. 34 1 

rubbing is prevented the tears will often wash the object 
away in a short time. If it adheres more firmly under 
the upper lid, the upper lashes should be seized with the 
fingers and the lid be pulled away from the eye and well 
down over the lower lid and then let go, when the lower 
lashes may sweep the offending body out. If this does 
not succeed promptly, the eye must be examined. Pull- 
ing down the lower lid reveals its lining and that of the 
lower half of the eyeball, but to examine the upper por- 
tions it is necessary to turn the upper lid inside out. The 
upper eyelashes must be dried and be seized between the 
finger and thumb, the mother standing behind the child. 
While the child is told to look well downward a blunt- 
pointed object, as a lead-pencil, is pressed against the 




Fig. 6o. — Method of everting the upper eyelid. 

middle of the upper eyelid and the lashes are pulled up- 
ward. It sometimes takes several trials to accomplish 
this (Fig. 60). 

The foreign body, if found, should be very gently re- 
moved with a moistened camel' s-hair brush. Irritation 
may persist for some time, and a simple eye lotion (Ap- 
pendix, 80), kept tepid, may be dropped frequently into 
the hollow between the eye and the nose and be allowed 
to trickle into the eye. If the brush fails to remove the 
object or if it cannot be found and the irritation con- 
tinues, a physician should be consulted. 

I^ime or acid in the eye produces a great deal of pain. 



342 THE CARE OF THE BABY. 

The eye should at once have poured into and over it water 
containing, in the first case, a little vinegar or lemon- 
juice, a teaspoonful to a glass, and in the second case 
baking-soda, a tablespoonful to the glass. Sweet oil is 
also useful in either case. A physician should be con- 
sulted immediately. 

Wounds of the Eye. — The eyeball may be cut by 
various sharp bodies, but the most serious wounds are 
those made by pointed instruments, such as scissors, 
forks, etc. , which penetrate into its interior. Sometimes, 
too, some sharp foreign body, as a splinter of metal or of 
stone, flies into the eye and passes within it. The pro- 
duction of a misshapen pupil is proof that the wound is 
actually a penetrating one. The absence of this irregu- 
larity is, however, not an evidence of the contrary. A 
penetrating wound is always serious, as it may not only 
cause the loss of the injured eye, but may even set up a 
sympathetic inflammation of the sound eye, and produce 
blindness in it also. Professional aid must be had at 
once. 

Foreign Bodies in tine Ear. — Children often put peas, 
shoe-buttons, beads, and similar objects into their ears. 
If the object is at all deeper in than the opening, its 
removal should be left to a physician. Should no physi- 
cian be available, the mother may try to do something 
herself. The child should be laid upon the affected side 
and the tip of the ear be strongly pulled outward and 
backward, thereby straightening the canal, whereupon 
the object will sometimes drop out of itself. If it does 
not, syringing with tepid water may be employed. For 
this purpose should be used the little bulbous syringe de- 
scribed on p. 277. In an emergency the syringe used for 



THE SICK BAB Y. 



343 



giving enemata may be employed. The child should be 
seated, the ear drawn outward and backward, and the 
nozzle placed at the upper part of the opening of the 
canal, in order that the water may get behind the object 
and wash it out while returning. 

After all, however, a foreign body in the ear does little 
harm as long as it is giving no pain. Certainly there is 
less risk in leaving it there until a convenient time comes 
for having a physician remove it than there is in unskil- 
ful meddling with it, which may only drive it further in 
or do harm to the canal or the drum. Sometimes an 
insect crawls into the ear and occasions much suffering 
by scratching against the drum-membrane. Sweet oil or 
castor oil should be poured in at once, and the ear 
syringed with water after about half an hour. 

Swallowing of Foreign Bodies. — The swallowing of 
such articles as coins, marbles, buttons, etc. usually need 
give no anxiety. It is often advised to give the child 
plenty of potato or bread to eat, on the ground that this 
coats the object and allows it to pass from the bowel 
without doing any harm. No laxatives are necessary. 
Sometimes, however, the body, especially if angular 
or pointed, such as a fish-bone or a pin, sticks in the 
throat and causes choking. If this occur, the child 
should at once be suspended by the feet and slapped upon 
the back in the effort to dislodge the object. If it is 
high in the throat, so that it does not produce complete 
obstruction to breathing, a cautious attempt should be 
made to grasp it with the finger and thumb. If it has 
seemed to stick some distance lower in the passage to the 
stomach, the child should be made to swallow several 
large mouthfuls of food, which may carry the body 
downward with them. 



344 ^-^^ CARE OF THE BABY. 

Foreign Bodies in the Nose. — As in the case of the 
ears, children often put small objects into the nose and 
forget their presence or fear to speak of it. At last an 
obstinate inflammation or discharge arouses the suspicion 
that something is wrong. If the object is not too far in, 
or is not too firmly held by the swelling of the mucous 
membrane or by its own increase in size, which the ab- 
sorption of moisture often produces, it may sometimes be 
removed by having the child blow its nose vigorously or 
by tickling the nose or giving snufif to produce sneezing. 
If this does not succeed, a physician should be sum- 
moned to remove the object, since injury follows unskil- 
ful efforts to get it out. 

Nose-bleed. — Some children are very liable to nose- 
bleed without any apparent reason, while others never 
have it except as the result of a fall or a blow. Among 
the causes are disturbances of the stomach, irritation of 
the nose by cold or by other causes, malaria, typhoid 
fever, and disease of the blood, heart, and liver. The flow 
of blood may become quite weakening, but is usually only 
slight. The child should be put at rest with the head 
elevated and held a little back. Firm pressure should be 
made on the upper lip at the outer edge of each nostril, 
or at the root of the nose just at the inner angle of each 
eye. This obstructs the flow of blood by compressing the 
arteries. If this does not answer, a piece of ice may be 
held on the forehead just above the nose, and another at 
the back of the neck; or, if this fails, the nose can be 
syringed with a solution of tannin in water (Appendix, 
82) and the child' given a mustard foot-bath. Both 
while the blood is still flowing and afterward, blowing of 
the nose must not be allowed. In very bad cases a 
physician may need to plug the nostrils with pieces of 



THE SICK- BABY. 



345 



cotton attached to strings, but this is seldom required. 
In cases, too, in which nose-bleed recurs often medical 
advice ought to be had. 

Poison-ivy Rash. — An intense inflammation of the 
skin may be produced by the leaves of several species of 
sumach. The one most commonly met with is the 
poison ivy {Rhus toxicodendron)^ a vine with dark-green, 
very shining leaves arranged in clusters of three and with 
the edges smooth or only slightly and irregularly toothed 
(Fig. 6i). It is found in abundance climbing over fences 
and trees in many localities. When it has nothing to 




Fig. 6i. — Leaf of the poison ivy. 



62. — Leaf of the Virginia creeper. 



climb on it forms a low, bushy growth two or three feet 
high, and is then called the poison oak. Nurses should 
be able to recognize the plant, in order that they may 
keep their charges away from it. The only common 
plant that at all resembles it is the Virginia creeper, 
which, however, has its leaves in clusters oi five (Fig. 
62). Some children can handle poison ivy with impu- 
nity, while others become badly poisoned by the slightest 



34^ THE CARE OF THE BABY. 

toucli or even by close proximity to it. The swamp dog- 
wood or poison elder {Rhus venenata) is another species 
of sumach even more virulent than the poison ivy. It is 
a shrub ten to eighteen feet high, with leaves in clusters 
of from seven to thirteen. Its situation in swamps makes 
it less dangerous to children. On the Pacific coast is 
still another poisonous species of sumach {Rhus diversi- 
loba)^ which also goes by the name of poison oak. 

The rash of poison ivy usually comes out within a few 
hours or a day after exposure. In this respect it differs 
from eczema, which is slower in its onset. The skin 
becomes swollen, red, hot, and itching, and is thickly 
covered with vesicles of from pin-head to split-pea size. 
These soon discharge their watery contents, which dry 
into crusts over the surface. The face often becomes so 
swollen that the child can scarcely open its eyes and is 
really a pitiable object. The disease lasts a week or 
longer, except in the very mildest cases. A useful appli- 
cation is a diluted preparation of Grindelia robusta (^ 
drachm of the fluid extract in 8 ounces of water). Thin 
cloths wet with this should be applied, allowed to dry, 
removed, re-wet, and reapplied. Sometimes an oily 
dressing will act more serviceably upon the heat and 
tenseness, as it is without the discomfort which attends 
the drying of a watery application. Thus, carbolized oil 
(Appendix, 72) diluted with an equal quantity of sweet 
oil may be smeared on the skin frequently. A very use- 
ful plan of treatment consists in dabbing the affected 
parts with "black wash" (to be purchased from the 
druggist), and, before they are quite dry, smearing them 
with oxide-of-zinc ointment. This may be done several 
times a day. In this connection may be mentioned the 
fact that various drugs are, in some persons, capable of 
producing eruptions upon the skin. 



THE SICK BABY. 347 

Fainting". — This consists of loss of consciousness, with 
pallor, due to a sudden temporary weakness of the heart. 
It is more apt to develop in later childhood than earlier. 
The child should be placed with the head low; some- 
times lower than the rest of the bod}^, and have the face 
slapped with a wet towel or water dashed into it. Access 
to fresh air should also be obtained. 

Drowning. — Drowning, or suffocation from any other 
cause, is an accident for which every mother ought to be 
prepared, as there is rarely time to send for medical aid. 
An effort should be made at resuscitation, even though 
there seem to be not the slightest chance of doing any 
good. As soon as the child is taken out of the water it 
should have the clothes loosened about the neck and be 




Resuscitation after drowninir : first movement. 



suspended or turned upon the face for a second or so, to 
allow the water to run out of the mouth. It should then 
be laid on the back with the shoulders slightly raised by 
a folded coat placed under them, but with the head 
touching the ground. The tongue should now have a 
handkerchief or cloth wrapped around it and be drawn 
well out of the mouth and held thus. Artificial respira- 
tion must now be commenced on the spot^ following what 



34^ THE CARE OF THE BABY. 

is known as "'Sylvester's method." Someone kneels 
behind the unconscious child, seizes the arms, and 
swings them around horizontally close to the ground 
until they meet above the head (Fig. 63). They are kept 
there for a moment, pulling upon them strongly the 
while. The whole manoeuvre lasts two or three seconds, 
and is intended to expand the chest and to make air 
enter it. The arms are then placed beside the chest and 
given a forcible push against the lower ribs (Fig. 64). 
This second manoeuvre lasts only about a second. Its 
object is to expel the air from the lungs. There should 




Fig. 64. — Resuscitation after drowning : second movement. 

be sixteen or eighteen of the artificial inspirations, and of 
course an equal number of expirations, made in one min- 
ute. The movements should be kept up for a long time 
— even as long as a couple of hours — until it is absolutely 
certain that the heart, not the pulse, has ceased beating. 
While artificial respiration is being conducted, someone 
should quickl}^ remove the wet clothing, dry the body, 
and apply warmth in any form — as hot water, hot bottles, 
stones heated in fires which may be built close by, hot 
sand if at the sea-shore, etc. The limbs should be 
rubbed in the direction from the extremities toward the 
heart, in order to favor the circulation of blood. When 



THE SICK BAB V. 349 

breathing begins the artificial respiration must be made 
to keep time with it as much as possible, so as to help 
and not to hinder it. The inhalation of smelling-salts 
and the shock produced by slapping the face with a wet 
cloth aid in inciting respiration. The child should be 
given stimulants in moderate amounts as soon as it can 
swallow. It ought not to be moved from the spot, un- 
less the coldness of the weather necessitates it, until it 
is thoroughly convalescent. 

Swallowing of Poisons. — Scarcely anything in the 
realm of household medicine can be more important than 
the treatment of poisoning in its various forms, since in 
this, of all things, knowledge, presence of mind, and 
promptness are of so much avail. Prevention is far bet- 
ter than cure, and can usually be accomplished by allow- 
ing nothing of a dangerous nature to be about. The 
precautions in the care of medicines detailed in Chapter 
X., pp. 212, 216, should be carefully followed, and the 
baby be kept from access to the match-box or to toys 
colored with poisonous pigments. 

The symptoms of the various forms of poisoning con- 
stitute too complicated a subject to discuss here. All the 
mother needs to know is what to do in case she suspects 
that poison has been taken. Of course some one will be 
sent for a doctor at once, with a message telling hwi what 
has happened^ and^ if possible^ what poison has bee^t swal- 
lowed. These details are most important in order that 
he may come prepared. At the same time the mother 
will begin treatment immediately. When the nature of 
the poison is unknown, the first thing to do is to empty 
the stomach by an emetic (Appendix, 106) or to encour- 
age vomiting in the same way if it is already going on. 
Next, some antidote must be given which is capable of 
neutralizing a good many different sorts of poisons. 



350 THE CARE OF THE BABY. 

Such an one is that known as JeauneV s general antidote 
(Appendix, 105), which neutralizes acids, arsenic, digi- 
talis, and zinc, and to some extent copper, morphine, 
and strychnine. It is of no value against phosphorus, and 
of but little against corrosive sublimate. After the anti- 
dote, which must be given freely, ' ' soothing drinks ' ' of 
various kinds should be administered, such as milk, raw 
white of eggs alone or dissolved in water, solution of gum 
arable, flour and water, flaxseed tea, barley-water, slip- 
pery-elm-water, etc. 

The following table shows in convenient form some of 
the principal poisons and their antidotes. The antidote 
italicized is the direct antagonist of the poison. In ad- 
dition, it may be stated that stimulants and external heat 
are needed in all cases of poisoning, of whatever sort, if 
the child grows cold and weak, and complete rest in bed 
in all except narcotic poisoning, as by opium and chloral. 
Artificial respiration may be tried whenever respiration 
seems disposed to cease. It is carried out in the same 
way as for cases of drowning. 

Table of Poisons and Antidotes. 

Poison. Antidotes. 

w^ - f Emetic, followed by Jeaunel's anti- 
Unknown J , ^ J ^i." J • 1 

I dote and soothing drinks. 

. . J ^- t, J 1,1 • r ^^ alkali, such as magnesia, chalk, 

Acid, acetic, hydrochloric, ^ •^- -, rn ji, 

' . .1 . { whitmg, soda, soap ; followed by 

sulphuric, nitric. .1 • -, • 1 .. -i 

I soothing drinks or sweet oil. 

^ . , . ,. . f Epsom salt in abundance ; soap ; no 

Acid, carbolic ; creosote • j ., 

f Emetic, followed by lime (as chalk. 

Acid, oxalic, including j plaster, whiting) or 7nag?iesia, but 

' * salts of lemon .' ' ] not by potash or soda ; then sooth- 

l^ ing drinks. 

A ., „. (■ Fresh air; ammonia to nostrils; cold 

Acid, prussic J , n ^-1= • 1 • ..• 

[ douche ; artificial respiration. 

{Emetic, followed b3' digitalis; no 
pillow under head ; free stimula- 
tion. 



THE SICK BABY. 



351 



Alcohol (brandy, etc .) . . 

Alkalies (as ammonia, spir- 
its of hartshorn, lye, caus- 
tic potash). 



Antimony (tartar emetic) 



Arsenic (Fowler's solution 
Paris green, " Rough on - 
Rats"). 



Emetic ; cold douche on head ; 
warmth and artificial respiration. 

Vinegar or lemon-juice, followed by 
soothing drinks or sweet oil. 

Emetic if vomiting is not already 
profuse ; then ta?inic acid freely, 
or strong tea ; later, milk or other 
soothing drinks ; finally, castor 
oil to empty the bowels. 

Emetic, quickly followed hy ple7ify of 
a fresh mixture of the tificture of 
chloride of iron with calcined 7?iag- 
?icsia, ZL'ashifig or baking soda, or 
water of aynmonia, or by featuieV s 
antidote. Then white of ^%z, sooth- 
ing drinks, or sweet oil ; castor 
oil to empty bowels. 



Atropine (see Belladoyina) . 
Belladonna (atropine) 



■■{ 



Chloroform, inhaled 



Copper (blue stone 
vitriol ; verdigris). 



Corrosive sublimate 



blue 



Emetic ; ta?mic acid freely ; cold to 
head ; coffee. Stimulants and 
warmth if needed. 
Blue stone ; blue vitriol (see Copper). 

Chloral Treatment as for opium-poisoning. 

Cold douche ; friction of skin ; in- 
verting child ; artificial respira- 
tion. 
Emetic, followed by white of egg or 
milk, yellow prussiate of potash ; 
then soothing drinks. 
Emetic, followed by white of egg or 
milk ; soothing drinks ; tannic 
acid freely ; castor oil to open 
bowels. 

Cyanide of potash (see Acid, prussic). 
Fowler's solution (see Arsenic). 

Gas(illuminatinggas, coal- J Fresh air; artificial respiration; 
gas). I ammonia to nostrils ; cold douche. 



352 



THE CARE OF THE BABY. 



Iodine 



I^audanum (see Opium) . 
Lead (sugar of lead) . . . 

Matches (see Phosphorus). 
Morphine (see Opium). 
Nux vomica (see Strychnine) 



Opium 
num, 
goric, 
etc.). 



(including lauda- 
morphine, pare- 
soothing syrups, 



Paregoric (see Opium). 
Paris green (see Arsenic). 



Phosphorus (match-heads, 
some roach and rat poi- 
sons). 



Poisonous plants (Jimson 
weed, poisonous mush- 
rooms, deadly night- 
shade, tobacco, etc.). 



Starch or flour mixed with water, 
given freely ; emetic ; soothing 
drinks. 

Emetic, followed by Epsom salt; 
white of ^gg or milk ; alum. 



Emetic (but generally useless) ; per- 
manganate of potash in doses of 4 
or 5 grains if case is seen early ; 
strong cojQfee ; atropine ; keep child 
awake and breathing by cold 
douche to head and spine, walk- 
ing, etc., but not to extent of ex- 
haustion ; artificial respiration. 



Emetic, esyec\2i\\y sulphate of copper, 
I to 3 grains in solution every ten 
minutes until vomiting ; then 
more copper or crude Freiich tur- 
pe7itine (other forms of turpentine 
useless) ; then Epsom salt or mag- 
nesia to open bowels, but no oil 
of any kind. 

{ Emetic, followed by tannic acid ; 

J strong coffee or brand}" ; ammonia 

I to nostrils ; external warmth ; ar- 

t tificial respiration . 



Prussic acid (see Acid, prussic). 

vSilver nitrate (lunar cans- f Table-salt, followed by emetic 



tic). 
Spoiled food 



Strychnine (nux vomica) 



Tartar emetic (see A?itimony). 



milk 
or white of eggs . 

Emetic, followed by castor oil as 
purgative. 

Emetic, followed by tannic acid, 
bro7?iide of potash freel}-, or chlo- 
ral. 



APPENDIX 



In this Appendix are grouped, for the sake of con- 
venience, a somewhat heterogeneous collection of sub- 
jects, which may be classified under — I. Dietary; II. 
Remedies for Local Use; III. Remedies for Internal 
Administration; and IV. Miscellaneous. The various 
minor divisions are numbered, and the references scat- 
tered here and there in the preceding chapters refer to 
these. 

I. DIETARY. 

Under this heading we may consider some of the 
special foods for babies and older children, particularly 
those intended for use in sickness. The preparation of 
ordinary articles, such as jellies, broths, soups, and the 
like, may be found described in any good cook-book, and 
is too extensive a subject to be touched on here. 

1. Dr. A. V. Meigs' Milk Mixture. — 

Milk, I part; 

Cream (by skimming; i6% fat), 2 parts; 

Lime-water, 2 " 

" Sugar- water, " 3 '' 

Sugar-water consists of 17^ drachms of milk-sugar dis- 
solved in I pint of water and kept as a stock liquid. 

2. Barley-Water. — Put i tablespoonful of whole barley 
into an enameired saucepan; boil for not more than five 
minutes and throw the water away. Then add ly^ pints 
of water; allow to simmer slowly down to i pint; strain. 

23 3i)3 



354 'THE CARE OF THE BABY. 

Often ordered as a diluent for, or as a temporary sub- 
stitute for, milk in cases of vomiting of infants. 

3. Albumen-Water. — The raw white of one or two 
eggs dissolved slowly in a glass of cold water. Sweet- 
ened if desired, and strained only if necessary to prevent 
clogging of the rubber nipple by minute shreds. It may 
be warmed only slightly before given. It is useful as a 
temporary nourishment when milk does not agree. 

4. Barley and Egg. — A combination of Nos. 2 and 3 
may be made as follows : 

Barley-water, 10 ounces; 

White of ^%%^ I ; 

White sugar, i to 2 teaspoonfuls. 

5. Oatmeal -Water. — Stir i tablespoonful of oatmeal 
into I pint of boiling water; cover and let simmer for an 
hour. Replace the water as it evaporates. Strain. 

Often prescribed in place of plain water for diluting 
milk when constipation exists. 

6. Arrowroot-Water. — Wet i teaspoonful of arrow- 
root with a little cold water and rub until smooth; then 
stir into i pint of boiling water and boil for five minutes, 
stirring all the while. 

Often added to milk mixtures to prevent the tendency 
to form hard curds. 

7. Toast-Water. — On two or three slices of bread, 
toasted dark brown, but not burned, pour f quart of boil- 
ing water; allow to stand until cool; strain. 

Useful in some cases of sick stomach. 



DIETARY. 355 

8. Rice-Water. — 

Rice (well washed), i ounce (i heaping tablespoonful); 

Warm water, i quart. 

Let stand an hour in a warm place ; then boil slowly to 
I pint; strain. 

Sometimes useful for diluting milk in cases of diar- 
rhoea. 

9. Gum-Arabic Water. — 

Gum Arabic, i ounce (i heaping tablespoonful); 

Boiling water, i pint. 
Dissolve; sweeten. Add the juice of a lemon for older 
children. 

Sometimes useful for infants in place of barley-water. 

10. Flaxseed Tea. — 

Flaxseed (whole), i ounce (i rounded tablespoonful); 

Boiling water, i pint. 
Let stand and keep warm for an hour ; strain ; sweeten. 
Add the juice of a lemon for older children. 

11. Gelatin Solution. — A piece of plate gelatin, two 
or three inches square, is soaked for a short time in cold 
water and then dissolved with stirring in >^ pint of boil- 
ing water. 

Sometimes used in place of barley-water. 

12. Dr. J. F. Meigs' Gelatin Food. — Gelatin-water 
is prepared as in the last formula. As soon as the gela- 
tin is dissolved, and while the water is still boiling, 
add I teaspoonful of arrowroot which has been previously 
rubbed up into a paste with a little cold water. Milk 



356 THE CARE OF THE BABY. 

and cream are added at the same time in varying pro- 
portions. 

The late Dr. J. F. Meigs found this to agree with many 
sick children when other foods failed. 

13. Whey. — To J^ pint of warm milk add i teaspoon- 
ful of essence of pepsin or liquid pepsin, or 2 teaspoon- 
fuls of liquid rennet. After it stiffens, beat up the curd 
with a fork. Strain off the whey. 

Useful for delicate stomachs which cannot bear milk. 

14. Cream-and-Whey Mixture. — 

Cream, 

Whey, 

Warm water, 2 ounces; 

Milk-sugar, i teaspoonful. 

15. Wine Whey. — While boiling ^ pint of milk add 
2 ounces of sherry wine. Strain. 

16. Veal Tea. — Cut fine i pound of veal as free from 
fat as possible; put into i^ pints of cold water; keep hot 
without boiling for three or four hours; strain; let cool; 
skim off the fat. 

Sometimes ordered in cases of weak digestion in in- 
fants. 

17. FIour-Ball. — Tie i pound of flour tightly in a bag 
and boil for ten hours. After it is cold take it out of the 
cloth and dry it for ten hours. Then peel off the outside 
coat of dough. The hard ball which remains should be 
grated when needed and mixed with milk in var}'ing pro- 
portions: I or 2 teaspoonfuls to 8 ounces of diluted milk 
is generally sufficient. 

Useful in some cases of delicate stomach. 



DIETARY. 357 

1 8. Beef Tea. — To i pound of lean beef, minced 
and free from fat, skin, and tendon, add i pint of water. 
Stir and let stand in an earthen vessel for an hour; then 
heat well, but without boiling, for another hour; strain 
and let cool. When about to use, remove all the fat with 
a piece of soft paper, warm, and season with salt. 

19. Beef Tea Rapidly Made. — Place i pound of 
scraped lean beef in ^ pint of boiling water in an 
enamelled saucepan; cover; keep gently warm for ten 
minutes; strain into a teacup, and place the cup in ice- 
water. When cold, skim off all fat, pour into a warmed 
cup, warm gently, season, and use. 

Beef teas made by this and the preceding recipe are 
more palatable than some of the ready-made beef-extract 
preparations, but have little nutritive value as compared 
with the peptonized beef foods on the market. 

20. Scraped Raw Meat. — Take a thick piece of raw 
tenderloin steak as free from tendon and fat as possible, 
scrape, grate or mince it very fine, and then pound it in a 
mortar until it is reduced to a pulp. Now rub it through 
a fine sieve; flavor with salt or sugar, and roll it into little 
balls. For younger children rub it up with a little water 
until it is of the consistence of thick cream, and feed it 
from a spoon. 

This is ver}^ nourishing in some of the wasting dis- 
eases. A child of a year or less should begin with not 
more than three teaspoonfuls during the course of a day. 
There is the possibility of tape-worm being acquired by 
the use of raw meat. To prevent this the steak may be 
cooked slightly first and then the brown outside layer 
cut away. 



358 



THE CARE OF THE BABY. 



21. Beef-Juice. — Season and very slightly broil a piece 
of steak free from fat; then cut it into small pieces and 
express the juice with a lemon- 
squeezer or, much better, with 
one of the meat-presses to be 
bought at the druggist's (Fig. 65). 
The juice can be warmed only 
slightly after it is obtained, or it 
may be given ice-cold. 




22. Lime - Water. — Place a 
piece of unslaked lime the size of 
an ^^^ in i gallon of water in an 
earthen vessel. Stir and let set- 
tle ; pour off the first water and 
add fresh. Keep covered to ex- 
clude the dust. Use from the top. Add water and stir 
from time to time. 



Fig. 65. — Meat-press. 



23. Peptonized Food. — The failure of the power of 
digestion renders predigestion (peptonizing) of the food 
necessary in some cases. Pepsin, the secretion of the 
stomach, may be utilized for this purpose, but for several 
reasons the secretion of the pancreas, often combined with 
bicarbonate of soda, is generally employed. Although 
there are various equally good pancreatic preparations on 
the market, such, for instance, as those of Parke, Davis 
& Co., and Armour & Co., yet for sake of convenience, 
and because it is very well known, the pancreatic extract 
of Fairchild Bros, and Foster is the one mentioned in 
the following recipes. Besides being sold in bulk, it 
is conveniently furnished in the form of "peptonizing 
tubes," each glass tube containing 5 grains of extract of 
pancreas and 15 grains of bicarbonate of soda. As the 



DIETARY. 359 

tubes are rather expensive, one can just as readily have a 
number of powders put up at a drug-store, each contain- 
ing the proper amount of pancreatic extract and soda. 

In the peptonizing of any food it is important to re- 
member that warmth is necessary for the action of the 
digestant, while cold checks it, and too great a heat de- 
stroys it altogether. The food undergoing peptonizing 
should be kept at a temperature of about 115° F. — that 
is, never so hot that the finger cannot be kept in it with- 
out discomfort. The peptonizing must not be allowed 
to become quite complete, or the bitter taste of peptones 
will be produced. This does not injure the food in the 
least, but makes the child unwilling to take it. The food 
should be tasted frequently during the process, and on 
the development of the slightest bitterness the tempera- 
ture should be quickly raised to the boiling-point or the 
food be put quickly on ice. The temperature of boiling 
is sufficient to destroy the digestant to a large extent, and 
consequently to interfere with further peptonizing. The 
chilling by ice arrests the action of the pancreatin, but 
only while the milk is kept cold. 

24. Peptonized Milk. — Add to 4 tablespoonfuls of cool 
water half of the contents of a peptonizing tube; stir 
until dissolved; add to 3^ pint of cool milk, and put the 
vessel containing this into water of a temperature of 
115° F. ; let it remain there for ten minutes, or for a 
shorter time if the slightest bitter taste develops. Then 
put at once on ice or, better, heat quickly to boiling. 

25. Sterilized Peptonized Milk-mixture. — Prepare 
the infant's milk-mixture according to the formula on 
page 135 or page 137. Then add the peptonizing powder 
in the proportion of one tube to each 8 ounces of com- 



360 THE CARE OF THE BABY. 

billed milk and cream. For instance, if the formula on 
page 135 is employed, and 16 per cent, cream used, we 
have in 8 ounces 2^ ounces of milk and cream. This 
will require about one-third of the contents of a pepton- 
izing tube. If 20 per cent, cream is used, or the top- 
milk formula followed, as on page 137, about one quarter 
of a tube will be enough. After adding the powder shake 
thoroughly, and peptonize as just described, finishing the 
process by raising the temperature quickly to that of 
boiling. Now place the proper amount of the food in 
each bottle, put the bottles in the sterilizer, and sterilize 
for half an hour. This will be long enough, on account 
of the previous scalding. 

Instead of this plan, we may mix the milk and cream, 
add one peptonizing tube to each 8 ounces, and pep- 
tonize. Then mix with milk-sugar and water according 
to the formula. The proper amount of food may now 
be placed in each bottle and sterilized. In either 
method neither soda solution nor lime water is needed, 
as the milk is already made alkaline by the peptonizing 
powder. 

26. Pasteurized Peptonized Milk Mixture. — Since 
the temperature employed in pasteurizing is not suffi- 
ciently high to arrest the action of the peptonizing pow- 
der, the only feasible method is to prepare the bottles of 
pasteurized milk as described on page 142, and to keep 
them until needed. Then, as each bottle is about to be 
used it should have added one-third or one-quarter of the 
contents of a peptonizing tube, according to the mixture 
employed (see Appendix, 25), be shaken thoroughly, stood 
in water of 110° to 115° F. for about ten minutes, cooled 
down slightly to the proper temperature for feeding, and 
given to the baby at once, before the peptonizing has a 



DIETARY. 361 

chance to advance too far. A little trial will show the 
length of time required in order to stop the process short 
of developing a bitter taste. 

27. Peptogenic Milk Powder. — This preparation fur- 
nishes a very convenient method of preparing a predi- 
gested milk-mixture which approximates the character 
of human milk, although, according to recent analyses, 
rather too rich in casein. It consists of a mixture of 
extract of pancreas, soda and other alkalies, and milk- 
sugar, and is so arranged that it may be measured out 
and mixed with the proper amount of water, milk, and 
cream according to printed directions. It is not so accu- 
rate a method as the use of peptonizing tubes, and is 
altogether a cruder process, while it does not present any 
decided advantage. 

28. Peptonized Beef Tea. — Mix 8 ounces of finely- 
minced beef, free from fat, with i pint of water. Sim- 
mer from one to two hours with frequent stirring. Cool 
down to 110° or 115° F. — that is, a temperature not hot 
enough to give discomfort to the finger held in it — and 
empty into it one peptonizing tube. Stir until dissolved. 
Keep at the same temperature for an hour or two with 
occasional stirring, avoiding any bitter taste. Then boil 
for a moment, strain, and season. 

29. Peptonized Oysters. — Boil for a few minutes in a 
saucepan half a dozen large oysters with their juice and 
^ pint of water. Remove the oysters, mince and mash 
them to a pulp, and put this into a glass jar with the 
broth. Add 15 grains of bicarbonate of soda and 15 
grains of extract of pancreas, and keep at 115° F. for 
one and a half hours or less, avoiding any decidedly 



362 THE CARE OF THE BABY. 

bitter taste. Then put into a saucepan, add J^ pint of 
milk, and heat to boiling. Season. 

30. Peptonized Gruel. — Gruel may be made in the 
ordinary way; as, for example: 

Arrowroot, fine oatmeal, wheat 
flour, sago, or other farina- 
ceous substance, i heaping teaspoon- 

ful or more; 

Cold water, J^ pint. 

Mix thoroughly and boil well for a few minutes with con- 
stant stirring until quite thick. Then stir in i pint of 
cold milk and strain into a jar. Empty in one pepton- 
izing tube. Keep warm (115° F.) for twenty minutes, 
or less than this if the faintest trace of bitterness 
develops. Then quickly raise it to boiling to stop 
further action. 



31. Peptonized Milk Toast. — Milk toast in which 
there is plenty of milk may be peptonized by making it 
into a pulp and then stirring in the contents of a pep- 
tonizing tube, and proceeding in the same way as for 
peptonizing gruel. 

32. Peptonized Milk Punch. — Fill a tumbler one-third 
full of crushed ice. Put in it as much stimulant as suits 
the age of the child (pp. 386, 389); fill up with pepton- 
ized milk ; sweeten according to taste, and grate a little 
nutmeg over the top. 

33. Nutrient Enemata. — For the giving of nutrient 
enemata one of the syringes already figured and de- 



DIETARY. 363 

scribed can be employed (pp. 240, 241). As the bowel 
has only feeble powers of absorption, it is better to have 
the food already in a predigested state. To ensure its 
being absorbed and retained it is better to have the food 
already in a predigested state and to give only ver}' small 
amounts at one time: ;4 to i teaspoon ful is enough at 
one year of age; i teaspoonful to i tablespoonful from 
one to four years; and from i to 8 tablespoonfuls up to 
twelve years. Any of the reliable peptonized meat 
preparations on the market may be employed in concen- 
tration much greater than is directed for use by the 
mouth. Such articles as defibrinated blood and other 
blood preparations, although not predigested, are readily 
absorbed and are of great value. 

Predigested nutrient enemata may be made at home 
by the use of pepsin or, especially, pancreatic prepara- 
tions. Milk peptonized in the way already described can 
be given, or the warmed milk may be mixed with the 
peptonizing agent and injected at once. 

34. Peptonized Beef Enema. — A peptonized beef 
enema may be made as follows: 

Add I tablespoonful of minced lean raw beef to 4 table- 
spoonfuls of water. Heat to boiling. Rub through a 
colander. When only warm, add the contents of a pep- 
tonizing tube and inject at once. 

35. Peptonized Egg Enema. — This is a useful nu- 
trient enema made by adding the contents of a peptoniz- 
ing tube to the white of one ^%% previously dissolved in 
three times its volume of water. 



364 THE CARE OF THE BABY. 

II. Remedies for Local Use. 

I. Baths. 

36. Baths in Sickness. — In a medical sense a ** bath '* 
is the application of water in nearly any way, either to the 
entire surface of the body or to part of it. Although 
there are many other varieties, we may limit our con- 
sideration to the following: 

[a) Whole baths, including — 

1. Sponge bath; 

2. Tub bath; 

3. Shower bath ; 

4. Sheet bath; 

5. Vapor bath ; 

6. Medicated bath (mustard, starch, soda, salt, 

sulphur, bran, disinfecting). 
(U) Partial baths, including — 

7. Foot bath; 

8. Wet compresses, including fomentations. 

From another point of view baths may be distinguished 
according to the temperature of the water. A convenient 
classification is the following: 

1. Cold bath, temperature of 40° to 70° F. 

2. Cool '' 

3. Tepid ^' 

4. Warm '' 

5. Hot '' 

These definitions of temperature are used in the descrip- 
tions which follow. 

37. Sponge Bathi or Ablution. — This is the simple, 
general washing of the body with wash-rag or sponge. 



u 


70° '' 


80° 


u 


(( 


80° '' 


90° 


(( 


u 


9c° " 


100° 


u 


( ( 


100° '' 


110° 


u 



REMEDIES FOR LOCAL USE. 365 

It may be used as a medicinal agent as well as for clean- 
liness. In sickness even more than ordinary care is 
needed to prevent taking cold. The sick child should 
be undressed completely, unless too weak, and put 
between blankets. The sponging must be performed 
rapidly and under the covers, doing one part at a time 
and drying it before going to another. Follow the order: 
hands, arms, face and head, neck, chest in front, back, 
abdomen, lower extremities. 

The child should be rolled from one side to the other 
if too weak to be lifted. The sponge or wash-rag need 
not be wet enough to be sloppy. 

Tepid spo)igi)ig or cool spoNgifig is an excellent means 
of reducing fever. Cold sponging is still more so, but 
must not be given except by a physician's order. The 
sponging may last ten or fifteen minutes and be repeated 
every couple of hours or oftener as needed. The addition 
of alcohol or bay rum adds to the cooling effect. When 
the fever is threateningly high and cold sponging is to 
be used, the child should not be covered at all; a rubber 
sheet is placed beneath the blanket, and the sponge may 
be large and saturated with water. On account of the fear 
which some physicians have of the use of water in 
eruptive fevers, no sponging at all should be used in such 
cases until the doctor has been consulted. Sponging 
with bathing-whiskey or with a mixture of equal parts 
of alcohol and water containing all the alum that will 
dissolve in it is useful where there is much perspiration 
or when the skin seems tender and liable to become sore 
(Appendix, 83). Alum will not dissolve at all in alco- 
hol alone. 

38. Tub Bath. — The use of the tub for washing has 
already been described. The warm tub bath is of service 



366 THE CARE OF THE BABY. 

in disease, but must be given with the greatest precau- 
tions against subsequent chilling. It is often ordered for 
the purpose of bringing out and keeping out the eruption 
of measles or scarlet fever in severe cases in which the 
gravity of the symptoms seems to depend on the failure 
of the rash to develop properly. It may well be given at 
the onset of any acute disease. It is also useful for pro- 
ducing perspiration and in this way checking a cold, 
allaying nervous excitement and thus producing sleep, 
reducing moderate fever, and stopping an attack of con- 
vulsions or of spasmodic croup. To get the full effect 
the child should be taken from the bath after ten or more 
minutes' immersion, placed quickly between warm blank- 
ets without being dried, and covered well in bed. When 
the bath is used to produce sleep, the child may be dried 
and the blanket dispensed with. Cases of eruptive fevers 
should not be given warm baths — except the initial one — 
unless medical advice be first obtained. 

The cold or cool tub bath should be used for medical 
purposes only if the physician orders it. It is not 
often given to young children unless there is high fever 
which cold sponging fails to reduce. In later childhood 
it is probably the best method known at the present 
time for treating typhoid fever. In order to avoid fright 
it is often best to put the child in a warm bath and then 
gradually cool the water until the proper temperature is 
reached. This is called the graduated bath. 

The hot tub bath is a very powerful stimulant, rarely 
to be used without the physician's order. Sometimes a 
baby which seems to be rapidly failing in strength or 
growing cold, or becoming greatly oppressed in breath- 
ing from some disease of the lungs, will revive in a 
wonderful manner if plunged into a bath of ichd° or iio° 
F., kept there one to three minutes, taken out, and 



REMEDIES FOR LOCAL USE. 367 

wrapped in blankets without drying. Of course, gentle- 
ness and absence of sudden movement are absolutely es- 
sential in such threatening states. It must also be said 
that the hot bath sometimes appears to make the child 
worse. In such a case it must be discontinued at once. 

39. Shower Bath. — The cool shower bath is to be used 
only in later childhood as an excellent nervous and 
muscular stimulant. The cold shower bath should never 
be used unless a ph}sician orders it. 

40. Sheet Bath, or Wet Pack. — This may be either 
hot or cold. To give a cold pack^ a rubber cloth should 
be put over the bed and a sheet be wrung out in cold water 
and laid upon it. The child is now stripped, placed upon 
and enveloped in the sheet with the exception of the head, 
and then wrapped outside of all with a blanket. The 
feet may be left out if it is desired, in order that a hot- 
water bag may be put to them should this seem advis- 
able. The cold pack is often useful to quiet very great 
nervousness and to produce sleep. The child may be 
left in it for an hour or so if it goes to sleep; or, if it 
does not, may be taken out in fifteen minutes and 
wrapped in a warm, dry blanket. The pack is also em- 
ployed for reducing moderate fever, but in order to be of 
any service it must be renewed every five or ten minutes 
ten or twelve consecutive times if the temperature is 
high; the whole process lasting about an hour. Where 
fever is extremely high a pack with ice-water is some- 
times employed. The child is stripped and covered with 
cloths dipped in the ice-water, not forgetting to place 
them on the head. The cloths must be redipped every 
two or three minutes, and the rectal temperature must 
be taken very frequently to guard against too great a fall. 



368 THE CARE OF THE BABY. 

A hot pack^ or blanket bath^ is given by wrapping the 
child in blankets wrung out in hot water, and covering 
with several dry blankets. The pack may be renewed in 
half an hour. It produces perspiration in the same way 
as the warm bath with subsequent blanket wrappings. 

41. Vapor Bath. — This is used to relieve the dropsy 
of Bright' s disease by producing profuse perspiration. 
The bed is well covered with blankets which reach nearly 
or quite to the floor, but which are kept oflf the child 
by half barrel-hoops or by a chair in the bed or in some 
other way. A stream of vapor from a kettle or pan of 
boiling water is conducted by a tin pipe beneath the 
cover, taking care that it does not come in too hot a 
state against the body. Other methods of producing 
vapor consist in placing a vessel of slaking lime, or a 
bucket of water with hot bricks dropped into it, under 
the bed in such a way that the vapor can rise at the sides 
and reach the child under the covers. 

The hot-air bath is used for the same purpose as the 
vapor bath, of which it is a modification. The hot air 
from an alcohol lamp is conducted under the covers by 
a tin pipe. With either of these baths great care must 
be observed that the bed clothing does not become ig- 
nited by the flame of the lamp. 

42. Mustard Bath. — Mustard is added to the warm 
tub bath in the proportion of >^ or i ounce (i to 2 mod- 
erately heaping tablespoonfuls) to i gallon of water. 
This is superior to the simple warm bath for bringing 
out the rash in eruptive fevers, and is a powerful 
stimulant when the child is rapidly failing from any 
cause. It is especially useful in infancy and early child- 
hood. 



REMEDIES FOR LOCAL USE. 369 

43. Starch Bath ; Starch -Water. — The starch bath 
should be made of the strength of >i a cupful of boiled 
starch to every 4 gallons of water. If the starch has 
jellied, it may be broken up with the hand or pressed 
through a coarse wet cloth. The bath is very useful for 
hives and some other irritating skin affections. 

Starch-water for washing the skin or for use in ene- 
mata may be made in the same way. For the latter pur- 
pose it may be a little thicker, so that it leaves a slightly 
sticky sensation on the fingers. 

44. Soda Bath. — This consists of i tablespoonful of 
washing soda to every 4 gallons of water. It is used for 
the same purpose as the starch bath, with which it is 
very commonly combined by dissolving the soda in the 
starch-water. 

45. Salt Bath. — This may be made by dissolving ordi- 
nary salt, rock salt, or prepared sea-salt in water in the 
strength of 4 ounces (4 heaping tablespoonfuls) to i gal- 
lon. Given tepid or cool and followed by brisk rubbing, 
it is a valuable tonic, especially for rickety children. 

46. Sulphur Bath. — This is made by dissolving 20 
grains of sulphide of potash in each gallon of water. It 
cannot be given in a metal tub. It is of service in 
chronic rheumatism and in some affections of the skin. 

47. Bran Bath. — Enough bran may be put in the water 
to make it milky. As this would choke the pipes of sta- 
tionary bath-tubs, the bath can be made by putting a 
pound or more of bran into a thin muslin bag and boil- 
ing this for a quarter of an hour. The water may then 
be added to the bath until it is milky. Bran baths are 
used in certain diseases of the skin. 

24 



370 THE CARE OF THE BABY. 

48. Disinfecting Bath. — (See Appendix, 95.) 

49. Foot Batii. — A partial bath of this sort is gener- 
ally given in the form of the hot mustard foot-bath, in the 
proportion of i ounce of mustard (2 moderately heaping 
tablespoonfuls) to i gallon of water. It is an excellent 
measure when a child has taken cold. Great care must 
be observed, however, to have the room warm, the bed- 
clothes also warm, and to ensure protection of the rest of the 
body, including the thighs, when the feet and legs are in 
the water. A useful plan is to have the tub in the bed, 
under the covers, while the child lies in bed well covered 
up. It is often best to put the child between blankets 
afterward, as in the case of the warm tub bath. 

50. Wet Compress. — This form of partial bath con- 
sists of a cloth wet with water and kept applied to some 
part of the body. An ordinary zuarm compress is made 
by folding a piece of soft cloth or of patent lint into two 
or three thicknesses, dipping it into tepid water, laying 
it on the part, covering it with a piece of oil silk or par- 
affin paper a little larger than the cloth, and gently band- 
aging it on. It is useful in reducing inflammation, as 
in cases of sore throat. 

A cold compress consists of a thin cloth, like a hand- 
kerchief, folded into two or three layers, dipped in cold 
water or, perhaps, in ice-water, wrung out, and laid on 
the affected part. Alcohol with twice its volume of ice- 
water is serviceable for this purpose. The compress is 
not covered with oil silk, and it must be changed every 
few minutes, since it rapidly becomes warm. Instead of 
this method, it may be kept cold by allowing ice-water 
to drop on it from a vessel higher than the patient. A 
strip of soft cotton cloth or a skein of darning cotton or 
a lamp-wick, with one end in the vessel and the other on 



REMEDIES FOR LOCAL USE. 37 1 

the compress, will supply enough fresh water. A rubber 
cloth should be placed under the compress in such a way 
that the child does not become wet. The cold compress 
is of service in inflammation, sprains, and the like. 

A hot compress^ or fomentation^ is made of a piece of 
flannel folded three or four times into the form of a pad. 
This is placed in an open towel, dipped into boiling 
water, wrung out thoroughly by twisting the towel, re- 
moved from it, tested by the nurse against her cheeks to 
ascertain that it is not too hot, applied to the part, and 
covered quickly with oil silk and a folded dry towel, with 
or without a bandage. The fomentation should be re- 
newed in half an hour if we wish to keep up decided 
heat. It is often very useful in relieving pain. A poul- 
tice is to be preferred, except that it is heavier. 

2. Poultices and Plasters. 

51. Poultices. — The poultice is intended to furnish a 
dressing which will retain its heat longer than a fomen- 
tation. It should be half an inch or less in thickness. 
The thicker it is the longer it stays warm, but of course 
the greater its weight. Placed on the chest, it must be 
thin or its weight will do harm. A poultice should 
always be tested against the cheek of the nurse before it 
is applied to the child, and should always be put on grad- 
ually. Of the various forms, those made of flaxseed, 
slippery elm, mush, bread, bran, hops, starch, mustard, 
and charcoal may be referred to. 

I 52. Flaxseed Poultice. — One of the best known and 
i most serviceable kinds. Heat a sufficient quantity of 
I water in a tin or china dish nearly or quite to boiling. 
I Add flaxseed meal slowly, stirring constantly and vigor- 
' ously with a spoon until it is of the consistence of hot 
mush, too thick to flow. Spread this with a case-knife 



1^2, THE CARE OF THE BABY. 

Upon a piece of cotton or linen cloth; fold the edges 
over slightly, and cover it with an old pocket-handker- 
chief or piece of thin muslin, cheese-cloth, or netting. 
Test to see that it is not too hot; apply, cover with oil 
silk or paraffin paper, and bandage on. Renew every few 
hours. The addition of a little oil will keep it soft longer. 
Everything must be in readiness before the poultice is 
mixed, or it will grow cold. 

53. Slippery-Elm Poultice. — Prepared from ground 
slippery-elm bark in the same way as the flaxseed poul- 
tice. 

54. Mush Poultice. — This is made of com-meal mush. 
It has no advantage over the flaxseed poultice. 

55. Bread-and-Milk Poultice. — A popular and easily- 
prepared poultice. Stale bread-crumb is stirred into hot 
milk until the proper consistency is attained. It should 
be kept hot a few minutes to ensure the bread being well 
softened, then spread and applied. Water may be used 
instead of milk. 

56. Bran Poultice. — When a flaxseed poultice would 
be too heavy, as in some cases of pain and tenderness in 
the abdomen, a bran poultice may be used. A flannel 
bag is partly filled with bran, thoroughly wet with boil- 
ing water, wrung out in a towel, and applied. 

57. Hop Poultice. — Prepared and used exactly as is 
the bran poultice, over which it has no particular advan- 
tage except that it is still lighter. 

58. Starch Poultice. — Thick boiled starch is spread 



REMEDIES FOR LOCAL USE. 373 

warm on a cloth and applied directly to the skin without 
any covering between. It is used to lessen irritation in 
some affections of the skin. 

59. Mustard Poultice. — The same as a mustard plaster 
(Appendix, 65). 

60. Charcoal Poultice. — This is made from flax- 
seed meal mixed with an equal quantity of powdered 
charcoal. More dry charcoal is sprinkled over it after it 
is spread. It was formerly often used as a dressing for 
foul-smelling sores and wounds. 

61. Jacket Poultice. — Sometimes a useful application 
in pneumonia. A piece of thin muslin or linen is used, 
long enough to go entirely around the chest, and wide 
enough when doubled to extend from the lowest ribs to 
the collar bones. The cloth is opened, the hot mass of the 
poultice spread on one half, the other half folded over it, 
and the poultice applied as hot as the child can bear it. 
Oil silk or paraffin paper covers it externally. The poul- 
tice should be renewed ever}' few hours, and the new one 
must always be ready to put on before the old one is taken 
off It should be drawn up close under the armpits and 
toward the collar bones and fastened over the shoulders 
and at one side with pieces of broad tape. The open 
edge of the poultice should be above, in order to prevent 
the contents falling out. 

A jacket poultice of bran may be made by construct- 
ing a jacket of muslin with a lining of the same sewed to 
it everywhere except at a single small opening through 
which the bran can be pushed. The poultice must be 
quilted to hold the bran in place, soaked in boiling water, 
pressed out, and applied when of the right temperature. 
The same poultice can be used again and again. 



374 THE CARE OF THE BABY. 

62. Antiseptic Poultice. — For use on open wounds, 
surgeons favor some form of antiseptic poultice, and ob- 
ject to flaxseed and other varieties already described. 
One of the best poultices consists of several layers of 
cheese-cloth or clean soft linen wrung out in a hot anti- 
septic fluid (Appendix, 75), laid on the wound, covered 
with paraffin paper, and bound on with a roller bandage. 

63. Turpentine Stupe. — A piece of flannel is wrung 
out in hot water, as in preparing a fomentation, and then 
sprinkled evenly with turpentine, about half a teaspoon- 
ful being used for each square foot of flannel. It is then 
applied, covered with oil silk and a dry towel, and left 
on half an hour to an hour, more or less, depending on 
the degree of irritation it produces. 

64. Spice Plaster. — This 'is a very serviceable applica- 
tion for infants with severe colic. To prepare it take i 
part each of ground ginger, cloves, cinnamon, and all- 
spice, with or without y^ part of cayenne pepper, 
according as the plaster is to be strong or weak. Put the 
dry and well-mixed powder into a flannel bag, spread it 
evenly, and quilt the bag to prevent the spices from get- 
ting into lumps. Before applying, wet it with hot alcohol 
or hot whiskey. The same spice-bag may be used repeat- 
edly until it begins to lose its strength too greatly. 

65. Mustard Plaster. — Strictly speaking, this is a 
poultice, since, as used for children, the mustard is added 
to flour or flaxseed meal, and the whole moistened and 
heated: i part of mustard should be mixed with 3 
or 4, or, in the case of infants, 5, parts of flour or flaxseed 
meal. Boiling water is added and the mixture stirred 
until it is of the proper softness. It is then spread on a 



REMEDIES FOR LOCAL USE. 375 

cloth and applied directly to the skin. If it burns too 
much, a layer of linen or some other thin material can be 
placed between. It should be kept on until the skin is 
well reddened, but not long enough to blister. 

66. Pepper Plaster; Nutmeg Plaster. — These old- 
fashioned but excellent preparations are of service in 
mild bronchitis or sore throat. Lard or, still better, 
mutton suet is spread evenly on a cloth and black pepper 
or powdered nutmeg dusted rather thickly over it. Red 
pepper may be used instead, but in smaller amount. The 
plaster may be worn for days over the chest or around 
the throat. Another plaster is made by mixing a very 
little cayenne pepper in a thin paste of flour and water 
and applying on a thin cloth. 

67. Cotton Jacket. — This is sometimes ordered by 
physicians in cases of pneumonia. A muslin waist 
should be made, reaching high in front and behind, 
and tying or pinning over the shoulders and down one 
side under the arm. To the inside of this a thick layer 
of cotton batting is loosely attached. If it. is desired to 
retain the perspiration and keep the skin moist, a layer 
of oil silk is sewed outside of the muslin, or the cotton 
may be sewed directly to the oil silk, cut in the shape of 
a waist. 



68. 



3. Ointments. 




Bismuth-and-Zinc Ointment. 




Subnitrate of bismuth. 


30 grains; 


Oxide of zinc, 


30 '' 


Lanolin, 


^ ounce; 


Vaseline, 


% " 



37^ THE CARE OF THE BABY. 

69. Ointment for Ringworm. 

Sulphur, J^ drachm; 

Tar ointment, i " 

Benzoated lard, i ounce. 

To be well rubbed in two or three times a day. 



70. 


Boric-Acid Ointment. 




Boric acid, i drachm; 




Vaseline, ^ ounce; 




Lanolin, J^ '* 


71- 


Boric-Acid-and-Zinc Ointment. 




Boric acid, ^ drachm; 




Oxide of zinc, >^ *' 




Lanolin, J^ ounce; 




Vaseline, i^ *' 



4. Solutions and Mixtures. 

72. Carbolized Oil. 

Pure carbolic acid (Calvert's 

No. i), y^ drachm; 

Finest olive oil, 2 fluidounces. 

This should be marked *' Poison!" 

73. Tannic-Acid-and-Glycerin Nipple Lotion. 

Glycerite of tannic acid, i fluidounce; 

Water, i 

To be painted upon the nipple and allowed to remain. 

74. Bismuth Nipple Lotion. 

Subnitrate of bismuth, i ounce; 

Castor oil, i fluidounce. 

To be used as the preceding. 



REMEDIES FOR LOCAL USE- 377 

75. Boric-Acid Lotion. 

Boric acid, J^ ounce; 

Water, i pint. 

To be used as an antiseptic wash in dressing wounds. 

76. Carbolic-Acid Lotion. 
Pure carbolic acid (Calvert's 

No. i), ^ drachm; 

Water, 6 fluidounces. 

To be used as the preceding. To be marked " Poison!'* 

77. Corrosive-Sublimate Antiseptic Lotion. 

Corrosive sublimate, ij^ grains; 

Tartaric acid, 6]/^ '' 

Distilled water, 8 fluidounces. 

To be used and marked as the preceding. Injurious to 
metal. 

A more convenient method of preparing it is to dis- 
solve in 3 pints of water one of the sublimate tablets 
which are for sale by druggists. Either method makes 
a solution of the strength of i of sublimate in 3000 of 
water. 

78. Starch-and-Boric-Acid Lotion. — Starch is to be 
dissolved in the boric-acid solution (No. 75) in the same 
way as when preparing ordinary starch-water (No. 43). 

79. Borax-and-Glycerin Lotion. 

Borax, 20 grains; 

Tincture of myrrh, J^ fluidrachm; 

Glycerin, i " 

Water, enough to make i fluidounce. 

Apply frequently to the inside of the mouth for inflam- 
mation or thrush. 



378 THE CARE OF THE BABY. 

80. Eye Lotion. 

Boric acid, 20 grains; 

Camphor-water, 2 fluidounces. 

81. Astringent Gargle. 

Tannic acid, i heaping teaspoonful; 

Water, i tumblerful. 

Dissolve and use as a gargle. 

82. Tannic-Acid Solution for Nose-bleed. 
Tannic acid, 2 drachms; 
Glycerin, i fluidrachm; 
Water, 2 fluidounces. 

To be injected or snuflfed into the nose in obstinate cases 
of nose-bleed. 

83. Alum Lotion. 

Alum, 6 drachms; 

Water, 8 fluidounces; 

Alcohol, 8 '' 

To be used as a wash in excessive perspiration or if bed- 
sores are threatening. 

84. Cooling Lotion. 

Pure carbolic acid (Calvert's No. i), 40 grains; 
Ether, 2 fluidrachms; 

Alcohol, 6 fluidounces. 

To be dabbed on the parts and let dry. To be marked 
"Poison!" 

85. Lotion for Freckles. No. 1. 

Compound tincture of benzoin, i fluidrachm; 

Glycerin, yi fluidrachm; 

Rose-water, 3 fluidounces. 



REMEDIES FOR LOCAL USE. 379 

86. Lotion for Freckles. No. 2. 

Borax, i drachm; 

Dilute acetic acid, yi fluidounce; 

Rose-water, }^ fluidounce. 

87. Injection for Convulsions. 
Bromide of potash, 10 grains; 
Hydrate of chloral, 3 " 

Milk of asafoetida, 2 fluidounces. 

One or two tablespoon fuls as an injection for an infant. 
To be repeated in half an hour if needed. 

88. Injection for Seat-worms. 
Quassia-chips, i ounce (i small teacupful); 
Water, i pint. 

Let soak for two or three hours. Inject slowly as much 
as the child will contain. 

5. Powders. 

89. Compound Camphor Powder. 
Camphor, i drachm; 
Oxide of zinc, % ounce; 
Starch, >^ ounce. 

Make into a very fine powder. 

90. Boric-Acid-and-Zinc Powder. 

Boric acid, >^ ounce; 

Oxide of zinc, j4 ounce. 

Make into a very fine powder. 

91. Bismuth-and-Zinc Powder. 

Subnitrate of bismuth, >^ ounce; 

Oxide of zinc, >^ ounce. 

Make into a very fine powder. 



380 the care of the baby. 

6. Disinfectants. 

92. Carbolic Acid. 

Carbolic acid (Calvert's No. 4), 6j^ ounces; 
Glycerin, 4 fluidounces; 

Water, i gallon. 

This forms a 5 per cent, solution suitable for disinfecting 
dishes, clothing, thermometers, metal work, and the 
hands of the nurse. Clothes should be soaked in it for 
several hours, then wrung out, carried away in a covered 
bucket, and boiled thoroughly. It may be used also to 
wet the sheet hung at the door. 

93. Chloride of Lime. 

Chloride of lime, 4 ounces; 

Water (soft), i gallon. 

A pint or a quart of this is to be thoroughly mixed with 
the passages from the bowels of typhoid-fever cases, 
covered, and allowed to stand for three hours before 
emptying. The solution may also be used to mix with 
any infectious expectorated or vomited matter. 

94. Chlorinated Soda. 

Solution of chlorinated soda, 6 fluidounces; 
Water, enough to make i quart. 

Useful for disinfecting the hands, eating utensils (except 
silver), etc., but not so suitable for clothing as No. 92. 
It may be used to wet the sheet in front of the door. 

95. Disinfectant Bath. — The solution No. 92 diluted 
with twice its volume of water, or No. 94 diluted with 
four times its volume, may be used for a final disinfecting 



REMEDIES FOR LOCAL USE. 38 1 

bath in which a child may be placed after an attack of 
scarlet fever or other contagious disease. 

96. Corrosive-Sublimate Solution. 
Corrosive sublimate, 2 ounces; 
Tartaric acid, 24 " 
Carminate of soda, 8 grains; 
Water, i quart. 

This is the formula of the Paris disinfecting service; 4 
ounces mixed with i gallon of water makes a solution of 
the strength of i part of the sublimate in 500 of water. 
The blue carminate of soda is added to give a slight color, 
so that the poisonous nature of the solution may be easily 
recognized. The solution is suitable for disinfecting 
floors, wood-work, leather, rubber, etc. It must not be 
used upon metal. Clothing may be disinfected by im- 
mersing it for two hours in a mixture of ]/> ounce of the 
stock solution and i gallon of water. There is some dan- 
ger, however, of its becoming stained by the carminate of 
soda. The sheet in front of the door of the room may be 
moistened with a mixture of 2 ounces of the stock solu- 
tion and I gallon of water. 

97. Corrosive-Sublimate Solution, No. 2. — One of 

the sublimate tablets referred to in No. yj^ dissolved in i 
pint of water, makes a solution of the strength of i part 
in 1000. This is by far the most convenient method of 
preparing the sublimate solution for disinfecting purposes. 

98. Disinfectant Vapor. 

Pure carbolic acid, i ounce; 

Oil of eucalyptus, i fluidounce; 

Turpentine, 8 fluidounces. 

Two tablespoonfuls may be poured on a quart of water in 



382 THE CARE OF THE BABY. 

a shallow pan, and this kept constantly simmering in the 
room of a diphtheritic patient, for the purpose of moist- 
ening and disinfecting the air. Fresh solution must be 
added from time to time. The flame must be kept well 
away from the liquid. 

99. Dry Disinfectants. — Dry copperas (sulphate of 
iron) or chloride of lime may be placed in large amounts 
in water-closets, water-pipes, cesspools, and the like, for 
the purpose of disinfecting them. 

III. Remedies for Internal Administration. 

100. Soda-Mint. 

Bicarbonate of soda, yi drachm; 

Aromatic spirits of ammonia, )^ fluidrachm; 

Spearmint-water or peppermint- 
water, enough to make 2 fluidounces. 
A teaspoonful in hot water at one year of age. 

loi. Laxative Alkaline Mixture. 

Bicarbonate of soda, ^ drachm; 

Spiced syrup of rhubarb, 4 fluidrachms; 

Syrup of senna, 4 " 

Syrup of orange, i fluidounce. 

A teaspoonful, more or less, three times a day at one year 
of age, depending upon the intensity of its action. 

102. Chalk-and-Bismuth Mixture. 

Subnitrate of bismuth, i^ drachms; 

Chalk mixture, 2 fluidounces. 

A teaspoonful every three hours or oftener at one year of 
age. A younger child requires a dose not much 
smaller than this. 



REMEDIES FOR INTERNAL ADMINISTRATION 383 

103. Fever Mixture. 

Sweet spirits of nitre, i^ fluidrachms; 

Citrate of potash, 30 grains; 

Syrup of lemon, 4 fluidrachms; 

Water, enough to make 2 fluidounces. 
A teaspoonful every three hours at one year of age. 

104. Croup Mixture. 

Syrup of ipecacuanha, 2]/^ fluidrachms; 

Bromide of potash, ^ drachm; 

Hive syrup i fluidrachm; 

Cinnamon- water, 1234 fluidrachms. 
A teaspoonful every hour or two for three or four doses 
at two years of age. 

105. Jeaunel's General Antidote for Poisoning. 

{a) Calcined magnesia, 2 ounces; 

Animal charcoal, i ounce; 

Water, 20 fluidounces. 

(I)) Monsel's solution of iron, 2 fluidounces. 

When needed, the two solutions should be mixed to- 
gether, shaken hard, and given two tablespoonfuls at a 
time, repeated very frequently. 

106. Emetics. 

A teaspoonful or more of syrup of ipecacuanha, repeated 
in fifteen minutes. 

A glass of warm water with as much common salt as it 
will dissolve. 

A half teaspoonful of alum stirred up in syrup or in 
molasses. 



384 THE CARE OF THE BABY. 

A teaspoonful of mustard in a large quantity of warm 
water, if other emetics fail. 

IV. Miscellaneous. 

107. Massage. — This is a procedure which no one is 
capable of carrying out as it should be done unless trained 
well and long in both its theory and its practice. Still, 
where a skilled masseuse cannot be obtained, the mother 
or nurse can perhaps do something, and it is certainly 
worth the trial; but it should be attempted only imder 
the advice and direction of the physician, who can at least 
give some idea as to what he desires and the method of 
procedure, even though he be no adept himself. 

Massage often does more good in cases of paralysis 
than any other plan of treatment. Children suffering 
from general debility or from chronic catarrhal condi- 
tions of the stomach and bowels are often aided greatly 
by it. Constipation and colic in babies are frequently 
much relieved by rubbing and kneading the abdomen, 
provided this is done in the proper way (p. 254). There 
are, indeed, many conditions in which massage finds a 
useful sphere. 

There are various technical terms used to designate the 
diSerent manipulations. Prominent among these are 
effleurage (stroking), friction (rubbing),/^/r?>j^^^ (knead- 
ing), and tapotement (tapping). The method of perform- 
ing each of these and the conditions in which they are 
specially useful is far too large a subject for consideration 
in a book of this nature, even were it profitable to speak 
further of a matter for which actual demonstration is the 
only satisfactory^ explanation. 

108. Table of Approximate Equivalent Measures. — 
The following table shows the relative vahie of drops, 
teaspoonfuls, fluidrachms, fluidounces, etc. : 



\ 



MISCELLANEOUS. 385 

1 minim (T1\,j) =1 drop water, or 2 drops tinctures, 

spirits, or wines. 
30 minims = \ fluidrachm (fl^ss) = i coffeespoonful. 
60 " =1 " (fl3J) = i teaspoonful. 

2 fluidrachms =2 teaspoonfub = i dessertspoonfiil. 

4 " =\ fluidounce (fl5ss)=4 ** = i tablespoonful. 

8 " =1 " (ti^j} = 2 tablespoonfuls. 

2 fluidounces =4 '* =1 wineglassful. 

8 « =\ pint (Oss) . . . = I tumblerful. 
16 " =1 « (Oj). 
32 " =2 pints =1 quart. 

8 pints . . =4 quarts = I gallon (Cj). 



For measuring minims we ought to have one of the 
small minim glasses sold by druggists 
(Fig. 66). Very commonly medicines 
are given by drops instead of minims. 
In such a case we must never forget 
that the drop is of a very variable size, 
depending upon both the nature of 
the liquid and the nature of the ar- 
ticle from which the drop falls. To 
be exact we should purchase an ac- 
curate medicine-dropper (Fig. 67), 
and have the druggist test it, no mat- 
ter how reliable it is claimed to be. 
An accurate dropper will give 60 drops 
of water to the fluidrachm; that is, i 
drop equals i minim. Alcoholic solu- 
tions, however, such as most of the 
tinctures and spirits, and whiskey and 
other stimulants, drop about 120 drops 
to the fluidrachm; that is, 2 drops 
equal i minim. Consequently, if the Fig. 66.— Minim glass 
physician orders a drop of laudanum, (natural size). 

and the mother uses the minim glass, she must measure 

25 




386 



THE CARE OF THE BABY. 



out only half a minim. This difference which sometimes 
exists between the drop and the minim is a matter of the 




Fig. 6'] . — Medicine-dropper. 

very greatest importance. For measuring larger doses 
teaspoons and tablespoons are very unsatisfactory, since 
they vary so much in size. The ordinary measuring 
glasses, although much better, are also in- 
accurate. It is much wiser to purchase a 
four-ounce glass graduate from the druggist 
(Fig. 68). 




Fig. 68. — Four- 
ounce glass grad 
uate. 



109. Table of Proportionate Dosage at 
Different Ages. — The size of a dose varies, 
first, with the age of the child; second, 
with its size; third, with the nature of the 
disease; fourth, with the individual medi- 
cine. There can, indeed, be no absolute 
rule, and there are numerous exceptions, for children 
bear some drugs in proportionately much larger doses 
than adults do, while certain others they can take in only 
the minutest quantities. As a rule, the actual age is not 
so much the basis of calculation as that age to which the 
length and weight of the child correspond. 

The following table forms a general guide for the 
different periods of life: 

Adult I 

18 3'ears | or i 

12 " h 

8 to 10 5-ears f 

6 years \ 



MISCELLANEOUS. 387 

4 years \ 

3 " \ 

2 " \ 

I year ^ 

9 months tV == t dose of i year. 

6 " ^ = \ " I " 

Birth to 3 months tu = i '* i " 

no. Dose List for Children One Year Old. — Accord- 
ing to the previous table (No. 109), the dose at 2 years is 
approximately one and a half times, at 3 years twice, at 
6 years three times, at 8 to 10 years four times the 
amounts given below, while the doses at less than i year 
may likewise be determined by consulting the same table. 
As has been frequently stated elsewhere in this book, no 
mother should attempt to prescribe for her child. This 
list is given solely for nurses and for the sake of that 
general information which never comes amiss, and which 
may prove useful in cases of great emergency where a 
physician cannot be found. It is especially to be remem- 
bered that opium is the drug to which children are par- 
ticularly susceptible. Remember, too, the difference 
between drops and minims. (See page 385.) 

AcetaniUd (antifebrin) gr. i to J. 

Aconite, tincture n\^ i to }. 

Ammonia, aromatic spirits of tt\^ 2 to 4. 

Antimony, wine of tt\^ 2 to 4. 

Antipyrin gr. 1 to ^. 

Asafcetida, milk of i*^\\.o\. 

Belladonna, tincture rr\^ ^ to 2. 

Bismuth, subnitrate gr. i to 6. 

Brandy (see Stimulants). 

Bromide of potash or soda gr. ^ to 4. 

Calomel gr. ^ to ^ (^ in 

one single dose). 

Cascara cordial tt\^ 4 to 30. 

Cascara sagrada, fluid extract tt\^ i to 4. 

Castor oil f3 ^ to i. 



388 THE CARE OF THE BABY. 

Catechu, tincture tt\^ 5. 

Cinnamon-water f3 j to i. 

Chalk mixture f3 i to i. 

Chloral gr. ^ to 3. 

Chlorate of potash gr. i. 

Citrate of magnesia (see Magnesia). 

Citrate of potash gr. i to 2. 

Cod-liver oil f3 i to i. 

Digitalis, tincture TT\,^toi. 

Dover's powder gr. \ to \. 

Epsom salt gr. 3 to 10. 

Fowler's solution of arsenic tt\^ ^ to i. 

Gin (see Stimulants). 

Ginger, tincture tt^ i to 4. 

Hive syrup (see Squills, comp. syrup of). 

Hoffmann's anod3ne tt\^ i to 5. 

Hydrochloric acid, dilute tt\^ i to 2. 

Iodide of potash gr. ^ to i. 

Ipecacuanha, syrup or wine tt\^ i to 5. 

Iron, citrate gr. Ho i. 

Iron, reduced gr. ^ to ^. 

Iron, syrup of iodide n\^ i to 3. 

Iron, tincture of chloride tt\^ 2 to 2. 

Kino, tincture ^ 5- 

Laudanum. [A tincture] n^ J to |. 

Liquorice powder gr. 2 to 4. 

Magnesia gr. 5 to 20. 

Magnesia, citrate (liquid) f3 i to 2. 

Malt extract tt\^ 10 to 15. 

Manna gr. 5 to 10. 

Morphine gr. tto to ^^j. 

Nitre, sweet spirits of n^ 2 to 6. 

Nux vomica, tincture . . tt\^ 1 to i. 

Olive oil iZ\^o\. 

Paregoric. [A tincture] tt\^ 3 to 10. 

Peppermint-water fo * to i. 

Pepsin gr. i to I. 

Phenacetin gr. i to ^. 

Quinine gr. ^o i. 

Rhubarb, syrup of fo ¥ to ^. 



MISCELLANEOUS. ' 389 

Salicylate of soda gr. ^ to i. 

Senna gr. i to 4. 

Senna, syrup n^ 10 to 15. 

Soda, bicarbonate . gr. i to 2. 

Squills, comp. syrup n\, i to 2. 

Squills, syrup n\^ i to 5. 

Stimulants : 

Brandy rr^ 5 to 30. 

Gin rn, 5 to 15. 

Port wine n\^ 5 to 30. 

Sherry n\^ 5 to 30. 

Whiskey n\^ 5 to 30. 

Sulphuric acid, dilute tt\^ ] to 4. 

Tannic acid gr. ^ to i. 

Whiskey (see Stimulants). 
Wine (see Stimulants). 

III. Medicine Closet. — The contents of the medicine 
closet, to which reference was made in Chapter X., p. 216, 
should be somewhat according to the following list. This 
contains, among other things, articles useful for accidents, 
including poisoning. The list may be curtailed in some 
respects, but suffers consequently in completeness. Those 
liquids marked with an * are for external use or are dan- 
gerous. They should be in poison-bottles. 

List of Articles for Medicine Closet. 

Glass graduate marked with fluidrachms and fluid- 
ounces; minim glass; accurate dropper; hard-rubber 
syringe holding four or six ounces; small druggist's 
hand scales for weighing medicines; camel's -hair 
brushes; small straight dressing- forceps; a pair of scis- 
sors; absorbent cotton; several one-inch and two-inch 
roller bandages, one to three yards long; patent lint; old 
linen; a spool of rubber adhesive plaster; court plaster; 
paraffin paper or oil silk; * alcohol; whiskey; olive oil; 



390 THE CARE OF THE BABY. 

* ammonia water; * turpentine; glycerin; * distilled fluid 
extract of hamamelis (witch-hazel) for bruises; *soap 
liniment for sprains; * tincture of iodine; * solution of 
boric acid for washing cuts (No. 75); flaxseed meal; 
mustard; magnesia; vaseline; castor oil; zinc ointment; 
soda-mint; baking soda; sweet spirits of nitre; aromatic 
spirits of ammonia; bromide of potash in 20-grain pow- 
ders, to be divided according to the age; * tincture of 
digitalis; syrup of ipecacuanha; tannic acid for use in 
poisoning; Epsom salt for poisoning; vinegar for poison- 
ing; sulphate of copper in 3-grain powders, for poisoning 
by matches; Jeanne? s antidote for poisoning. 



INDEX, 



Abdomen, conditions of, in disease, 
224 

enlargement of, in colic, 256 
in pregnancy, 20 
in rickets, 315, 316 

massage of, 254, 384 

of child, size at birth, 36 
Abdominal band. See Binder. 

belt for pregnancy, 26 
Accidents, 329 
Air, fresh. In pregnancy, 22 

moistening of, 202, 214, 309 

out-door exposure to, 165, 166 
Albumin-water, 354 
Alum solution, 365, 378 
Amusements, 1 71-174 

in pregnancy, 24 
Antiseptic lotions, 377, 380, 381 
Appetite, loss of, 235, 250, 320 
Applications, external, 238, 242, 364 
Apron, bath-, 69 

creeping, 103, 168 
Arms, short, at birth, 37 
Arrowroot-water, 354 
Atomizer, bulb, 242 

steam, 214, 263 

Baby, characteristics of, in health, 34 

-jumper, 169 

method of carrying, 165, 236, 335 

sensations of, 49 

-talk, 167 

use of the term, 18 
Baby's basket, 66 
Backwardness, 272 
Bag of waters, 33 
Bandage. See Binder. 

roller-, method of applying, 330 
Barley and egg, 354 

-water, 353 
Barrel-hoojis to keep covers off, 368 
Barrow coat, 90 
Basin, sponge-, 73 



Bassinet, 160 
Bath apron, 69 

blanket, 368 

bran, 369 

daily, 71 

disinfectant, 370, 380 

duration of, 70, 77, 80, 366 

fear of, 74 

first, 68 

foot, 370 

for a prematurely-born child, 314 

graduated, 366 

hot-air, 368 

hour for, 78 

method of giving, 69 

mustard, 368 

powder after, 79 

salt, 369 

sheet, 367 

shower, 367 

soap for, 75 

soda, 369 

sponge, 364 

starch, 369 

sulphur, 369 

temperature of, 70, 76, 78, 364 

thermometer, 76 

towels for, 78 

tub, 70, 365 

vapor, 368 

water for, 76, 77 
Bathing. See also Bath. 

during pregnancy, 22 

for sleeplessness, 78, 268, 366, 367 

importance of tub-, 74 

room for, 207 
Baths in disease, 238, 364 

out-door, 79 
Bath-tub, 71, 72, 74 

stand for, 71, 72 
Bed, airing of, 163 

-clothes-fasteners, 164 

confinement to, during sickness, 236 

391 



392 



INDEX. 



Bed- covers, 162, 163, 237 

for confinement, 31 

for infant, 160 

furnishing of, 162 

in sickness, 237 

-room shoes, 109 

trundle-, 162 

warming of, 163 

-wetting, 322 
Beef-juice, 358 

effect on urine, 231 
Beef-tea, 357 

peptonized, 361 
Bibs, 102 
Bicycle, 172 

Biedert's cream mixture, 150 
Binder for child, 86, 97, 104, 105 

for mother, 31, 32 
Birth-marks, 25, 283 

-palsy, 270 

premature, 313 
Bismuth-andzinc ointment, 375 

powder, 379 
Bismuth nipple lotion, 376 
Bites of animals, t^^-^, 334 
Bladder, irritability of, in pregnancy, 

23 
Blanket, pinning, 90 

shoulder, 94 

to receive baby at birth, 68, 69, 94 
Bleeding, arrest of, 330, 331 

from navel, 283 

from nose, 344 
Blindness, congenital, 273 

from inflammation of the eyes, 273 
Blue baby, 324 
Body, feebleness of, in idiocy, 273 

-movements in early life, 47, 48 
Boils, 248, 288 

Bones, broken or displaced, 335 
Boots, rubber, 108 
Borax-and-glycerin lotion, 377 
Boric-acid-and-zinc ointment, 376 

powder, 379 
Boric-acid lotion, 377 

ointment, 376 
Bottle-feeding. See Feeding, artificial. 
Bottle, feeding-. See N'lirsing bottle. 

for poisons, 216 

-tip. See Alpple. 
Bowel, closure of, 257 

inflammation of, 251 

itching of, 222, 259 



Bowel-movements. See Passages. 

prolapse of, 257 
Bowels, teaching control over, 51, 171 
Bow-legs, 37, 169, 316 
Brain, concussion of, 328 

disease of, 222-226, 250, 269-272, 
278 

water on the. See Hydrocephalus. 
Breast, abscess of, 117, 120, 319 

caked, 117 

feeding at. See Feeding. 

-pump, 27 
Breasts, care of, 27, 116 

distention of, 117, 119, 319 

enlargement of, in pregnancy, 20 

inflammation of, in infants, 319 
Breath, holding the, 317 
Breathing. See Respiration. 
Bright's disease, 223, 231, 322, 368 
Bronchitis, 263, 264, 375 
Brooder, 314 
Bruises, 334 
Brush for head, 82 

for throat, 24I 

tooth-, 81 
' Burning child, 337 
, Burns, 336, i^^Z 

\ Cap, 95, 104, 107, 108 
I Carbolic-acid antiseptic lotion, 377 
! disinfectant solution, 380 
Carbolized oil, 376 
Carriage, 167, 168 

"express-wagon," 169 
prevention of falling from, 167 
Carrying the child in sickness, 236, 

335 
method of, 165 
Cart, 170 
Cereals, 152, 155 
Chafing, 287 
Chair, nursing-, 171, 204, 254 

-car, 170 
Chairs for nursery, 204, 207 

for school-room, 219 
Chalk-and-bismuth mixture, 382 
Chapping, 288 

Character, training of, 174, 179, 190 
Chest in disease, 224 

in health, 36, 58 
Chicken-breasted, 224, 249 

-pox, 302, 304 
Chilblains, 339 



INDEX. 



393 



Childbirth. See Confinement. 
Childhood, disorders of, 220, 244 

early and later, definition of, 18 
Child's nurse. See Ntirse-tnaid. 
Chloride-of-lime solution, 380 
Chlorinated-soda solution, 380 
Choking, 343 
Cholera infantum, 251 
Chorea, 269 
Cleft palate, 245 
Cloak, 95, 104 

Clothes-basket for early exercise, 168 
Clothing. See also Petticoat, Shirt, etc. 

after shortening, 98, 104 

difference in heat depending on 
color, 106 

different styles of, for infants, 90 

disinfection of, 210 

during pregnancy, 26 

during sickness, 109 

for different sexes, 106, 107 

fornight, 94, 107 

for out-doors, 95, 104, 107 

general remarks on, "^i 

in couveuse, 314 

of childhood, 104, 108 

of infancy, 86, 104 

undergarments, material for, 85 
Club-foot, 37, 278 
Coat, 104, 107 

rubber, 108 
Cold, application of, 239 

effect of, on child, 34, 84, 339 

in the head, 261 
Colds treated by bath, 366, 368, 370 
Colic, 112, 222, 225, 256, 384 
Color of skin, 34, 35, 222 
Colors, absorption of heal by, 106 
Colostrum, no 
Comb, 82, 292 
Comforter, 145 

Compound camphor powder, 379 
Compresses, wet, 370 
Confinement, "bag of waters," 33 

bed for, 31 

binder, 32 

calculating date of, 21-23 

napkins, 32 

l)ains of, 32 

preparations for, 30 

room for, 31 

" show," II 
Constipation, 253, 256 



Constipation in pregnancy, 28 

Consumption, 223, 224 

Contentment, 174 

Convulsions, 222, 223, 265, 366 

Cooling lotion, 378 

Cord, navel. See A'avel cord. 

Corrosive-sublimate antiseptic lotion, 

377 

disinfectant solution, 381 
Corsets, 106 
Corj'za, 261 
Cotton underwear, 86 
Cough, signification of, 226 
Couveuse, 314 
Cow-pox, 304 
I Cracks in skin, 287 
Cradle, 162 
Cream, 122, .i^, 132, 133, 135 

-and-barley water, 150 

-and-whey mixture, 356 

mixture, Biedert's, 150 
Creamometer, 122, 123, 132 
Creeping, 48, 168 

apron, 103, 163 

pen for early exercise, 168 
Crib, 161, 162 
Croup kettle, 214,263 

membranous, 263 

mixture, 383 

spasmodic, 262 

tent, 215 
Cr)', signification of, 38, 1 1 2, 224, 323 
Curd, " breaking of," 150 
I Curvature of spine. See Spine. 
Cuts and tears, 329 
Cyanosis, congenital, 324 

Dancing, 172 
Dandruff, 289 
Day of the disease, 293 
Deafness, 252, 262, 272, 277 
Dentition. See also Teeth and Teeth- 
ing. 

delayed, 64 

disordered, 60, 247 
Despondency in pregnancy, 24 
Desquamation, 296 
Diaper-cover, rubber, 89 

-squares, 89 

-suspenders, 100 
Diapers, baby, 88 

leaving off of, 104 
Diarrhoea, 223, 224, 237, 251 



394 



INDEX. 



Diet. See also Food^xi^ Feeding, 
after three years, 155 
after weaning, 151 
from eighteen months to two years, 

153 
from one year to eighteen months, 

152 
from two to three years, 154 
influence on breast-milk, 114, 115, 

124 
in pregnancy, 25 
necessity of caution in changing, 117, 

147, 152^ 154, 235, 243 
of nursing mother, 113, 124 
Dietary, 243, 353 
Diphtheria, 270, 307 
Diseases, contagious, 182, 197, 209- 
212, 293 
due to unhygienic school-room and 

schooling, 181, 217 
features of, 221 
infectious, 182, 197, 292, 294 
of bones, muscles, skin, etc., 277 
of brain and nervous system and of 

the special senses, 265 
of digestive apparatus, 245 
of organs of respiration, 261 
record of, 243, 244 
Disinfectant vapor, 309, 381 
Disinfectants, 380 
Disinfection about body, uselessness of, 

293 

in contagious diseases, 210 

of wash-stand, 206 
Dislocations, 335 
Disorders of childhood, 244 

of pregnancy, 28 
Disposition, alteration in pregnancy, 21 
Dog-bites, 333 
Donkey, 172 

Dose of common remedies for chil- 
dren one year old, 234, 387 

size of, at different ages, 386 
Drachm, fluid, 385 
Draughts, 68, 168, 200, 201, 203, 213, 

218 
Drawers, 99, 104, 105, 108 

night-, 107, 108 
Dress for childhood, 105 

or slip for infancy, 92 
Dressing, method of, 95 

the cord, 95, 96 
Drops, 385 



Dropsy in children, 224, 321, 368 

in pregnancy, 29 
Drowning, 347 
Drying, 71, 78 
Dysentery, 252 

Earache, 276 

Ears, foreign bodies in the, 342 

inflammation of, 261, 276 

injury by bath, 75, 80 

protruding, 278 

washing of, 75 
Eczema, 225, 284, 290, 292, 346 
Emergencies, 329 
Emetics, 383 
Enemata for convulsions, 379 

for thread-worms, 379 

nutrient, 362 

syringes for, 339, 240 
Epilepsy, 266, 267 
Eruptions, pustular, 288 
Erj'sipelas, 305, 306 
Erythema, 288 
' Exercise, calisthenic, 173 

clothes-basket or pen for, 168 

express- wagon or mail-cart for, 169 

for nursing mother, 1 15 

gymnastic, 173, 1 81 

infant's earliest, 165 

in pregnancy, 22 

large amount borne by child, 171 

length of out-door walk, 169 

trotting on knee, 170 
Expectoration, age when begun, 263 
Express-wagon, 169 
Eye, acid in the, 341 

dropper, 274 

foreign bodies in the, 340 

lime in the, 341 

lotion, 378 

wounds of the, 342 
Eyelashes, effect of cutting, %-^ 
Eyes, color of, 37 

crossing of, 223, 265, 270, 275 

first washing of, 70 

half-open, 223 

inflammation of, 222, 273 

injuiy of, by study, I Si, 219, 269 

purplish tint about, 223 

Face, expression of, in disease, 223 

in health, 37 
Fainting, 347 



I 



INDEX. 



395 



Falling backward, 49 
Falsehoods, 175, 190 
Fearlessness, 178, 193 
Features of disease, 221 
of health, 34-46, 221 
Feeble-mindedness, 271 
Feeding. See also Nursing, Diet, and 
Food. 
artificial, 125 
at the breast, no 

action on womb, no 
disadvantages to mother, 1 18 
length of time for, wt, 
method of, 112 
bottle-. See Feeding, artificial. 
-bottle. See Nursing bottle. 
by wet-nurse, 124 
frequency of, ni, 127, 152, 153, 

154 

from the bottle, 145 

discontinuance of, 152 
length of time for, 145 
position of baby, 145 

from cup or spoon, 1 19 

general rules for, 127 

hours for, 127, 128, 152-155 

in cleft palate, 245 

in first day or two of life, in 

in sickness, 157, 235, 242, 353 

prematurely-born children, 314 
Feet, cold, 43, 102, 256, 321 

deformity of, 278 

turned in at birth, 37 
Fever, 46, 228, 319 

baths for, 365-368 

-blisters, 289 

giving of water in, 235, 321 

-mixture, 383 

relation to pulse and respiration, 229 
Fevers, eruptive, 293 
Fire, child a-, 337 

-place, 200, 202, 213 
Fish-hooks, wounds by, 332 
Fits. See Convulsions. 
Flaxseed tea, 355 
Floor, draughts on, 168, 200, 203 

playing on, 168, 203 
Flour-ball, 356 
Flowers in nursery, 205 
Fomentations, 371 
Fontanelles in disease, 224, 271, 315 

in health, 36, 58 
Food. See also Diet, Feeding, and Milk. 



Food, abstinence from, in acute dis- 
ease, 235, 242, 250, 252, 256 

cereal, 156 

character of, for baby, 109, 128 

gelatin, 149, 355 

heating of, 145, 217 

increase of fat in, 253 

peptonized, 150, 153, 358, 363 

prepared beef-, 153, 357, 363 

quantity required, 125 

relation to size and weight, 127 
Food, starchy. See Starch. 

table-, injuriousness of, 15 1 

to suit individual child, 147 

warming of, 144 
Foods, patented infants', 131, 148 

permitted after three years, 156 

to be avoided, 156 

to be taken cautiously, 156 
Foot, clubbed, 278 

reproduction of imprint, 102 
Forehead, wrinkling of, 223 
Foreign bodies in the ear, 342 
in the eye, 340 
in the nose, 344 
swallowing of, 343 
Foreskin, narrow, 323 

washing of, 75 
Forwardness, 178 
Fractures, 335 
Freckles, 338, 378, 379 
Freezing, 339 
French measles, 301 
Frights during pregnancy, 25 
Frost-bite, 339 
Fumigation, method of, 2n 
Furuncle, 288 

Games and sports, 1 71-174 
Gargle, 378 
Gastric juice, 60 
Gate to nursery, 204 
Gelatin solution, 355 
Gentleness, 177 
German measles, 301 

enlarged glands in, 318 
Gertrude suit, 90, 92, 93, 96 
Gestures in disease, 222 
Glands, abscess of, 299, 329 

enlarged, 318 
Governess, 191, 218 
Gown, night-, 94, 97, 107 
Graduate, glass, 234, 286 



396 



INDEX. 



Gravel, 231 

Grinding of teeth, 230, 259, 265 

Growth, general remarks on, 46 

Gruel, peptonized, 362 

Gum-arabic water, 355 

Gum-boil, 248 

Gums, See also Mouth. 
lancing of, 60, 247 
rubbing tooth through, 248 

Gymnasium, 173 

Habits, 313 
Hair-brush, 82 
Hair, care of, 75, 82 

change of color of, 59 

new growth of, 59 

on body, 34 

on head, falling out of, 30, 36, 59 

pulling at, 213 
Hand, movement to seat of pain, 

222 
Hands, cold, 256, 320, 321 

deformity of, 267 

hot, relation to fever, 320 
" Hardening," 85, 165 
Hare-lip, 245 
Hat, 107, 108 
Head, deformity of, at birth, 35, 277 

fontanelles. See Fontanelles. 

holding erect, 48, 272 

in disease, 221, 223 

perspiration of, 223, 315 

size and shape, 35, 58, 224, 271, 277, 

315 
Headache, 268 
Health, features of, 34, 221 
Hearing at birth, 47 

increase in power of, 49 

in idiocy, 272 
Heart disease, 317 
Heat, application of, 238 
Heating, methods of, 202, 212 
Height. See Length. 
Hemorrhage. See Bleeding. 
Hemorrhoids in pregnancy, 29 
Hernia, 258 
Hiccough, 319 
Hip-joint disease, 279 
Hips at birth, 36 
Hives, 286 

Hoarseness, 226, 262, 263, 300, 308 
Hood, 95, 107 
Hoop, rolling of, 171 



Horse, 172 

Hydrocephalus, 224, 271, 278 

Ice, method of keeping, 217 

Ice-bags, 239 

Idiocy, 271 

Imitation, power of, 175 

Incubation, stage of, 295 

Incubator, 314 

Indigestion, chronic, 223, 250 

in pregnancy, 30 
Infancy, definition of, 18 
Initial symptoms, 296 
Injections, See Enemata. 
Inquisitiveness, 175 
Insonmia, 267, 366, 367 
Intellect. See Mind. 
Intelligence. See also Mind. 

at birth, 37, 47 

growth of, 47, 50 
Invasion, stage of, 295 
Isolation, 296 
Itch, 291 

Jacket, cotton, 375 
Jaundice, 35, 222, 261 
Jaunting car, 169 
Jaw, V-shaped, 326 

Jeaunel's general antidote for poison- 
ing, 350, l^l, 390 
Joints, dislocation of, 335 
enlargement of, 315, 317 

Kindergarten, 179 
Knock knees, 316 

Labor. See Confinement. 

Lactometer, 131 

Lameness, 279 

Lap-protector, 97 

Laryngitis, 225, 263 

Laughing, 50 

Laxative alkaline mixture, 382 

Layette, 96 

Leggings, 104, 108 

Legs, bending of, 37, 169, 316 

crooked, at birth, 37 

short, at birth, 37 
Length at birth, 34, 53 
" increase in, 52-57 

measure for determining, 56 
Leucoixhoea in childhood, 324 

in pregnancy, 30 



INDEX. 



397 



Lice, 292 

Lighting, methods of, 207, 219 

Lime-water, 358 

disadvantages of, 135, 142 
Lisping, 327 

Lists. See Tables and Lists. 
Liver at birth, 36 
" Longings," 2i 
Lotions, 376-379 
Lungs, congestion of, 264 

inflammation of, 264 
Lying, 175. 196 

Macule, 295 
Mail-cart, 169 
Management of pregnancy, 22 

of sick children, 231 
Marasmus, 223, 319 
" Markings " on children, 25, 283 
Massage, 173, 254, 384 
Masturbation, 329 
Maternal impressions, 25, 2S3 
Mattress, material and protection of, 
31, 162 

renovating, 2II, 212 
Meals, number and hours, 127, L28, 

152, 156 
Measles, 223, 299 

French, 301 

German, 301 

glands in, 318 
Measure for determining length, 56 

for milk-sugar, 136 
Measures, table of eiiuivalent, 3S5 
Measuring of medicines, 234, 3S5 
Meconium, 41, no 
Medicine closet, 216, 389 

-dropper, 38$ 

-glasses, 234, 3S6 

method of giving, 232-235 
Medicines, care of, 212, 216, 349 

size of dose of, 234, 385, 386 
Meigs' gelatin food, 149, 355 

milk mixture, 135, 353 
Membranous croup, 263, 308 
Menstruation, absent in pregnancy, 20 

influence on breast- milk, 120 
Merino underwear, 86 
Miliaria, 284 
Milk. See also Feeding and Food. 

acidity, test for, 133 

albuminoids of, 122, 123, 124, 129, 
130 



Milk, Alderney, 131 

amounts at different ages, 127 
ass's, 129 

boiled, 130, 138, 142, 225 
breast-, 1 10 

analysis of, 129 

approximate analysis of, 123 

best nourishment for child, 109 

influence of diet on, 114, 115, 124 
of drugs on, 114 
of emotions on, 115 
of menstruation on, 120 
of pregnancy on, 120 

insufficient supply of, 115, 120 

modification of,' 124 

quantity secreted, 113 

time flow begins, lio 
-cake, 117 
casein of, 130 
condensed, 149 
cow's, analysis of, 129 

artificially-colored, test for, 133 

care of, 131 

characteristics of, 1 29-1 31 

mixed herd preferable, 174 
cream of. See Cream. 
-crust, 279 

fat in, 122, 124, 129, 130, 134 
goat's, 129 
mare's, 129 
mixture. Author's formula for, 135 

increasing strength of, 12S, 151 

Meigs', 135, 353 
mixtures, to substitute mother's milk, 
general remarks on, 131, 144 
Pasteurized, 142, 360 
peptonized, 359-361 
poisonous, 115, 138 
punch, peptonized, 362 
regurgitation of, 1 13, 250 
salt added to, 134, 235 
sterilized, 138, 361 

digestibility of, 142 

for travelling, 141 

preservation of, 141 
-sugar, 134, 136 

measure for, 136 
teeth. See Teeth. 
toast, peptonized, 362 
top, 137 

wet-nurse, no influence on traits of 
child, 186 
Mind. See also Intelligence. 



398 



INDEX. 



Mind, effect of pregnancy on, 24 

over-use of, 180, 181 

training of, 174, 178, 179, 181, 190 
Minim glass, 385 
Minims, 385 

Miscellaneous disorders and habits, 313 
Mittens, 95, 97, 104 
Moccasins, icx) 
Mole, 283 
Monthly nurse. See Nurse. 

periods. See Menstruation. 
Moral character, training of, 174-179, 

190 
Morals, supervision over, 179 
Morbilli, 299 
Mosquito-bites, 333 
Mother, disadvantages of nursing to, 
118 

ignorance of, 17 
Mother, nursing-, diet of, 113, 1 15, 124 
exercise and fresh air for, 1 1 5 
use of stimulants by, 115 
Mother's marks, 283 
Mouth, appearance in teething, 61 

-breathing, 221, 249, 325 

hand in, 222 

inflammation of, 246, 247 

washing of, 70, 80, 234 
Movement, pain on, 221 
Movements of body at birth, 47 
increase in power of, 47 
in disease, 222 
in health, 37 

of bowels. See Passages. 
Mumps, 312 

NiEVUS, 283 

Nails, biting the, 326 

care of, 83 

condition at birth, 36 

toe-, ingrowing, 278 
Napkins for baby. See Diapers. 

for confinement, 32 
Nature, love of objects in, 177 
Nausea, 223, 256 
Navel, bleeding from, 283 

cord, dressing of, 95, 96 
falling off of, 96 

ulcer of, 282 
Neatness, 174, 191, 196 
Needle, wound by, 332 
Nettle-rash, 286 
Night-clothes, 94, 97, 104, 107, 108 



Night-terrors, 267 
Nightmare, 267 
Nipple, artificial, 116 
for cleft palate, 245 
-protector, 27 
rubber, care of, 146 
collapsing of, 146 
-shield, 116 
ventilated, 147 
with tube, objection to, 146 
Nipples, care of, during nursing, 116 
during pregnancy, 27 
fissures of, 27, 1 1 2, 1 16, 1 17 
hardening of, 27 
retracted, 27, no, 116 
Noise natural to child, 175 
j Nose, foreign bodies in the, 344 
I picking at, 222 
I Nose-bleed, 344, 378 
Nostrils, moving of, 223 
Number, idea of, 50 
Nurse, child's. See Nwse-maid. 
"experienced," 183, 190, 196 
monthly, choice of, 183 
duties of, 184 
incompetence of, 17 
trained, dress of, 196, 197 
duties of, 232 
privileges of, 197 
qualifications of, 196 
record kept by, 243, 244 
wet-, hygiene of, 186 

milk without influence on traits of 

child, 186 
objections to, 124 
qualifications of, 184 
supervision over, 187 
Nurse-maid, age of, 189 
" don'ts " for, 192 
duties of mother to, 194 

to the child, 192 
French, 194 
German, 194 
qualifications of, 1 88-1 92 
supervision over, 187, 194 
untxustworthiness of, 188 
upholding authority of, 194 
-maids, training-school for, 192 
Nursery, attractiveness of, 204 
ceiling, floor, and walls, 203 
chair, 171, 204, 254 
cleanliness of, 205 
cloth, 31 



INDEX. 



199 



Nursery, day, 199 

flowering plants in, 205 
furnishing of, 203, 204, 207 
gate to, 204 
governess, 191 
heating of, 202 
lighting of, 207 
night, 206 
pictures in, 204 
position in house, 199, 206 
refrigerator, 217 
size of, 200 

temperature of, 203, 207 
ventilation of, 200-202, 206 
wash-stand in, 205 
windows to, 199, 20i, 203, 204 
Nursing. _ See also Feeding. 
bottle, 144 

smoothness of, 145 

sucking at, when empty, 145 

ventilated, 147 

washing of, 145 

with long tube, 146, 246 
influence of pregnancy on, 120 
manner of, by sick child, 230 
of contagious disease, 197, 209-212 

Oatmeal-water, 354 
Obedience, 176, 177, 232 
Ointments, 375 
Onset of disease, 296 
Ophthalmia, 273 
Ounce, fluid-, 385 
Oysters, peptonized, 361 

Pack, wet, 367 

Pain, growing, 279, 317 

in knee and hip, 279 

on movement, 221, 225, 315, 317 

on passing urine, 322, 323 

result of chilling, 256 
Pains during confinement, 32 
Pajamas, 107 
Palate, cleft, 245 
Palsy, 270 
Pancreatic juice, 150 
Papule, 296 
Paralysis, 270 

at birth, 270 

diphtheritic 270, 309 

position in, 221, 222 

spinal, 270 
Parties, children's, 178 



Passages, habit of regularity, 171, 254 

meconium, 41, no 

mucus in, 250-252 

number and color in disease, 251- 
258 
in health, 41, 42, 65 

sponging after, 77 

straining at, 252, 254, 258 
Pasteurizing, 139, 142-144 
Pediculi, 292 
Pen, creeping, 168 
Peptogenic milk powder, 361 
Peptonized beef enema, 363 
foods, 358 
tea, 361 

egg enema, 363 

food, 150, 358 

gruel, 362 

milk, 359-361 
punch, 362 
toast, 362 

oysters, 361 
Perambulator. See Carriage. 
Perspiration of head, 223, 224, 315 

sponging for, 365 
Pertussis, 310 
Pets, 177 
Petticoat, 90 

Gertrude, 90, 92 
Phimosis, 323, 329 
Pigeon-toed, 49 
Piles in pregnancy, 29 
Pillow, 163 

on which to carry child, 97 
Pillows, renovating, 211, 212 
Pills, method of giving, 234 
Pint, 385 
Plaster, mustard, 374 

nutmeg, 375 

pepper, 375 

spice, 374 
Play, 48, 174 
Pleasure, sensations and expression of, 

50 
Pleurisy, 224, 225 
Pneumonia, 264 
Poison-bottle, 216 

elder, 346 

-guard, 216 

ivy, 345 
oak, 345, 346 
sumach, 345 
Poisons and antidotes, 350, 383, 390 



400 



INDEX. 



Poisons, swallowing of, 349 

Pony, 172 

Position during sleep, 158 

in disease, 221, 236 

in health, 38 

necessity of changing, 158 

when nursing, 112 
from bottle, 145 
Pott's disease of spine, 224, 281 
Poultice, antiseptic, 374 

bran, 372, 373 

bread-and-milk, 372 

charcoal, 373 

flaxseed, 371 

hop, 372 

jacket, 373 

mush, 372 

mustard, 373 

slippery-elm, 372 

starch, 372 
Poultices and plasters, 371 
Powder after bath, 71, 79 
Powders, 379 

method of giving, 234 
Precocity, 180 
Pregnancy, amusements in, 24 

bathing during, 22 

care of breasts during, 27 

clothing during, 26 

diet in, 25 

disorders of, 28 

duration of, 21, 23 

exercise in, 22 

importance of careful life during, 19 

influence on nursing, 120 

management of, 22 

maternal impressions, 25 

mental condition in, 24 

signs of, 19 
Prickly heat, 284 
Princess pattern, 90, 91, 92 
Prodromal symptoms, 296 
Puberty, 18, 58, 172 
Pulse during sleep, 41 

in disease, 227 

in health, 40, 65 

method of observing, 40, 41 

relation to temperature and respira- 
tion, 229 
Punishments, 176, 193 
Pustule, 296 

Quarantine, 182, 296 



Quart, 385 
Quickening, 21 

"Rash, bringing out the," 320, 366 

nettle, 285 

of eruptive fevers, 293 

stomach, 288 

tooth, 288 
Raw meat, scraped, 357 
Read, learning to, 175, 180 
Record, daily, of the disease, 243, 244 
Red gum, 284 
Refrigerator, nursery, 217 
Registers, 202 
Regurgitation, 113, 250 
Remedies for internal administration, 
382 

for local use, 364 
Respiration, artificial, 347 

Cheyne-Stokes, 226 

during sleep, 38, 39 

in disease, 221, 223, 224, 226 

in heahh, 38-40, 65 

method of observing, 40 

relation to temperature and pulse, 
229 

through the mouth, 221, 249, 325 
Restlessness, 221 
Rheumatism, 317, 369 
Rice-water, 355 
Rickets, 221, 223, 224, 278, 280, 282, 

314 
Ringworm, 290, 376 
Rocking-horse, 171 
Room for confinement, 31 

for school. See School-room. 

for sickness. See Sick-room. 

for sleeping, 164 
Rooms for child, different sorts of, 1 98 
Rope, skipping, 172 
Roseola, 301 
Rotheln, 301 
Rubber cloth for bed, 31, 32, 162, 163 

diaper-cover, 89 

garments, 108 
Rubella, 301 
Rubeola, 299 
Rupture, 258 

Sack, 95, 97, 102, 104, 108, 237 
Saint Vitus' dance, 269, 317 
Saliva, 59, 150, 246 

profuse flow in pregnancy, 29 






INDEX. 



40 T 



Scabies, 291 

Scalds, 336 

Scales for weighing child, 55 

Scarlatina, 297 

Scarlet fever, 231, 297 

rash, 297 
School, boarding, 181 

diseases developed at, 181, 182, 217, 
218 

gymnastic exercises at, 173 

kindergarten, 179 

-life, hours for study, 180 

recess at, 181 

-room, 217 

desks and chairs for, 218, 219 
lighting of, 2 [9 
size requiretl, 219 
ventilation of, 220 
Scrofula, 317 
Sea-baths, 79 

-voyages in pregnancy, 24 
Seeing, See Sight. 
Self-abuse, 329 

Selfishness, freedom from, 177 
Sensations, subjective, of baby, 49 
Servants, association of child with, 178 
Sex, determining before birth, 28 
Sexes, difference in clothing for, 106, 
' 107 

sports same for each, 172, 179 

supervision of morals of, 179 
Sheets, 31, 32, 162, 163 
Shirt, 91, 96, 104, 105, 107, 108 

Gertrude, 92, 96 
Shoe, outline of sole, 102 
Shoes, bed-room, 109 

heels to, 107 

moccasins, 100 

rights and lefts, loi 

rubber, 108 

soles to, 102, 107 
Shoulders at birth, 36 

" shrugged up," 281 
" Show " in confinement, 33 
Sick children, bathing of, 237, 238, 

364 
feedmg of, 157, 235, 242, 353 
management of, 221, 231 
Sickness, abstinence from food during, 
235, 242, 250, 252, 256 
bathing in, 237, 238, 364 
bed in, 236-238 
clothing during, 109 

26 



Sickness, feeding in, 157, 235, 242, 353 

morning, 20, 30 
Sick-room, 209 

anteroom to, 210, 212 

deodorizing of, 213, 238 

disinfection of, 210 

for contagious diseases, 209 

furnishing of, 210, 216, 217 

heating of, 212 

lighting of, 209 

moistening air of, 214 

neatness in, 212 

position of, 209 

(juiet in, 236 

temperature of, 215 

ventilation of, 212 
Sight at birth, 47 

defective, 273, 275, 276 

increase of power of, 49 

in idiocy, 272 
Sitting erect, 48 

in idiocy, 272 
Skating, 172 

Skin, chapping, chafing, and cracking 
of, 287 

color of, 34, 35, 222 

irritated by clothing, 86, 284 

moist, relation to fever, 320 

necessity of keeping covered, 84, 85, 
105 

roughness of, 287 

scraped, 332 

shedding of, 35, 296 
Skirts, 105 

advantage of shortness, 91, 106 
Sleep at breast not to be allowed, iii 

between blankets, 163 

during the day, 157, 159 

effect on pulse, 41 
on respiration, 40 

hours for, 157-160 

in disease, 221, 222, 223 

method of putting to, 158 

position during, ■}^^, 158 

room for, 164, 206 

starting in, 279 
Sleeplessness, 267, 366, 367 
Slip, 92 

Slipjiers not advisable, 109 
Small-pox, 303 
Smell, increase in sense of, 49 

sense of, at birth, 47 
Smiling, 50, 223 



402 



INDEX. 



Snake-bites, 334 

Snoring, 249, 325 

Soap, method of applying, 70 

stick, 255 

varieties of, 75 
Socks, 89, 97 
Soda-mint, 382 

-solution for milk mixture, 135, 142 
" Soothing drinks," 350 
Sounds, utterance of, 50 
Spasm. See Convulsions. 
Specific gravity glass, 121, 132 
Speech. See also Talk. 

defective, 327 
Spinal cord, paralysis fpom disease of, 

270 
Spine, curv^ature of, 165, 181, 279 
angular, 281 
lateral, 218, 280 
rickety posterior, 282 

Pott's disease of, 224, 281 
Splinters, 332 
Sponge, 70, 75 
Sponging, 71, 77, 237, 364 
Spoonfuls of different sorts, 234, 385 
Sports and games, 171, 174 

out-door, intended for both sexes, 
172, 179 
Sprains, 334 
Stammering, 327 
Standing, 48, 218 
Starch-and-boric-acid lotion, 377 
Starch in the food, 148 
age for allowing, 151 
difficulty of digesting, 150, 250, 
315 

test for, 149 

-water, 369 
Sterilizer, 138, 139 
Sterilizing, 139 

effect on digestibility of milk, 142 

method in detail, 139 

modified, 142 
Stimulants for child, dose of, 389 

use of, by mother, 1 14 
Stings by insects, 333 
Stockings, 98, 104, 105, 108 
Stomach cough, 226 

rash, 288 

secretion and movements of, 60 

size of, at birth, 126 
Stories suitable for children, 179, 193 
Strabismus, 275 



Strophulus, 284 

Study. See also Mind. 

hours for, 180 

injuring eyes by, 181, 219, 269 
Stupe, turpentine, 374 
Stuttering, 327 
Styes, 275 
Sucking at empty bottle, 146 

the thumb, 325 
Suffocation, 347 
Sugar, cane-, 134 

-measure, 138 

milk-, 134, 136 
Suit, Gertrude, 90, 92, 93, 96, 98 
Summer resorts, 173 
Sunburn, 338 
Supernumerary digits, 278 
Suppositories, 255 
Suspenders for diapers, 100 

for holding stockings, 98, 105 
Swallowing, manner of, in disease, 230 

of foreign bodies, 343 

of poisons, 349 
Swamp dogwood, 346 
Swedish movements, 173 
Swimming, 172 
Syringe, ear, 277, 342 

fountain, 30, 240 

infant's, 240, 254 

rubber, 241, 254 

Table, sitting at, 155, 178 

Tables and Lists : 

Amounts of urine passed daily, 43 
Analysis of breast milk, 129 
Approximate analysis of breast 

milk, 123 
Approximate equivalent measures, 

385 

Articles for baby's basket, 68 
for confinement, 31 
for medicine closet, 389 

Calculating date of confinement, 

23 
Circumference of head and chest 

at different ages, 58 
Clothes for earliest childhood, 108 
Comparative analysis of woman's 

and cow's milk, 129 
Diet from eighteen months to two 

years, 153 
from one year to eighteen 
months, 152 



INDEX. 



403 



Tables and Lists : 

Diet from two to three years, 154 

Doses of medicine for children 
one year old, 387 

Eruption of milk teeth, 63 
of permanent teeth, 65 

Foods permitted, 156 
to be avoided, 156 
to be taken cautiously, 1 56 

Formula for milk mixture, 135, 

137 

General rules for feeding, 127 
Growth in length and weight, 52 
Hours for feeding, 128 
Infants' weight chart, 54 
Infectious diseases, 294, 295 
Long clothes, 97 
Number of pulse-beats per minute, 

41 
of respirations per minute, 39 
Poisons and antidotes, 350 
Proportionate doses at different 

ages, 386 
Record of course of disease, 243, 

244 
Rules for modifying breast milk, 

124 
Short clothes, 104 
Time of eruption of milk teeth, 

63 
of permanent teeth, 65 
Top milk mixture, 137 
Tales suitable for children, 163, 193 
Talk. See also Speech. 

"baby," objection to, 175, 193 
Talk, learning to, 175, 190 
Talking in idiocy, 272 
Tannic- acid-and-glycerin nipple lotion, 

376 
Tannic-acid solution for nose-bleed, 378 
Tanning of the skin, 338 
Taste at birth, 48 
Tears, 38, 59, 226 
Tears and cuts, 329 
Teeth, cleaning of, 81 

decay of, in pregnancy, 29 
deciduous. See Teeth, milk. 
grinding of, 230, 259, 265 
milk, 61 

decay of, 64, 81, 248, 316 
falling out of, 64 
necessity for removing, 64, 72 
time and order of eruption, 62 



Teeth, permanent, 61 

time and order of eruption, 64 

present at birth, 63 

prominent, 326 

temporary. See Teeth, milk. 
Teething. See also Dentition. 

process of, 61 

relation to flow of saliva, 59 
Temperature chart, 244 

in disease, 228 

method of taking, 43 

normal, 43, 45 

of bath, 70, 77, 78, 364 
testing of, 76 

of nursery, 203, 207 

of sick-room, 215 

relation to pulse and respiration, 229 

sensation of skin to hand misleading, 

43 
Tennis, 172 
Thermometer, bath, 76 

clinical, 43, 44, 320 

nursery, 203 
Thirst, 112, 225, 235, 236, 321 
Throat, applications to, 241 

sore, 248, 370 
Thrush, 246 
Thumb-sucking, 325 
Toast-water, 354 
Tongue at birth, 36 

in disease, 229 

strawberry, 298 

-tie, 245 

" worm-eaten, 250 
Tonsils, acute inflammation of, 249 

chronic enlargement of, 221, 224, 
249 
Toothache in pregnancy, 29 
Tooth rash, 288 

rubbing through the gums, 248 
Tourniquet, 331 
Towels for bathing, 78 
Toys, 174 

poisonous, 349 
Trained nurse. See Nurse. 
Training-school for nurse-maids, 192 
Travelling, food for, 141, 149 
Trotting on knee, 170 
Tub, 71, 72, 74 
Tumblerful, 385 
Typhoid fever, 294 
cold bath in, 366 



404 



INDEX. 



Underclothes. See Clothing. 
Urine, amounts passed daily at differ- 
ent ages, 43 

frequent passage of, in pregnancy, 29 

in Bright's disease, 231, 322 

incontinence of, 322 

in disease, 231 

in health, 42, 65 

learning control over, 51, 104, 171 

pain on passing, 322, 323 

retention of, 42, 322 
Urinometer, 131 
Urticaria, 286 

Vaccination, 304 
Varicella, 302, 304 
Variola, 294 
Varioloid, 302, 303 
Veal tea, 356 
Veil, 95, 96, 104 
Veins, prominence of, 222 

varicose, in pregnancy, 29 
Velocipede, 171 
VeHtilating board, 200 
Ventilation, 163, 200-202, 206, 212, 

220 
Ventilator, wheel, 201 

window, 201 
Vesicle, 296 
Virginia creeper, 345 
Vision. See Sight. 
Vomiting, 235, 242, 250 

Waist for supporting clothing, 100, 105 
Walk, learning to, 48, 169 

stiff, 281 
Walking, discouraging of, 316 

in idiocy, 272 

pigeon-toed, 49 



Warmth, necessity of, 84, 1 05, 314 
Warts, 283 
Wash-rag, 70, 74, 75 

-stand in nursery, 205 
Water, necessity of giving, 112, 225, 
235, 236, 321 

on the brain. See Hydrocephalus. 
Waxy substance on skin at birth, 69 
W^eaning, 117, 151 

age for, 1 1 8 

early, reasons for, 1 20 

method of, 117, 119 

season of year for, 119 
W^eather-stripping, 203 
Webbing of fingers or toes, 278 
Weight at birth, 34, 52 

charts for recording, 54 

increase in, 51-54 

method of obtaining, 54 
Wet-nurse. See Xtirse. 
Wetting the bed, 322 
Whey, 356 

-and- cream mixture, 150 
Whooping-cough, 223, 230, 310 
Window bars, 204 
Wine whey, 356 
Wineglassful, 385 
Woollen underwear, 85 
Wonns, round, 260 

seat-, 259, 379 

tape-, 260, 357 

thread-, 259, 379 
Wounds, contused, 334 

mcised, 329 

lacerated, 331 

of the eye, 342 

lX)isoned, m 

punctured, 332 
Wrapper, 95, 97, 102, 104, 109 



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AN AMERICAN TEXT-BOOK OF PHYSIOLOGY. Edited by 
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HENRY H. DONALDSON, Ph. D., 

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FREDERIC S. LEE, Ph. D., 

Adjunct Professor of Physiology, Colum- 
bia University, N. Y. (College of 
Physicians and Surgeons). 



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Professor of Physiology, 
Michigan. 



University of 



GRAHAM LUSK, Ph.D., 

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W. T. PORTER, M.D., 

Assistant Professor of Physiology, Har- 
vard Medical School. 

EDWARD T. REICHERT, M.D., 

Professor of Physiology, University of 
Pennsylvania. 

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VOIiUME I. CONTAINS: 



Hygiene. — Fevers (Ephemeral, Simple Con- 
tinued, Typhus, Typhoid, Epidemic Cerebro- 
spinal Meningitis, and Relapsing). — Scarla- 
tina, Measles, Rotheln, Variola, Varioloid, 
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Urine (Chemistry and Microscopy). — Kid- 
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Bronchi) and Pleura. — Pharynx, (Esophagus, 
Stomach and Intestines (including Intestinal 
Parasites), Heart, Aorta, Arteries and Veins. 



— Peritoneum, Liver, and Pancreas. — Diathet- 
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thritis, Gout, Lithsemia, and Diabetes.)— 
Blood and Spleen. — Inflammation, Embolism, 
Thrombosis, Fever, and Bacteriology. 



The articles ai-e not written as though addressed to students in lectures, but 
are exhaustive descriptions of diseases, with the newest facts as regards Causa- 
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number of approved formulae. The recent advances made in the study 
of the bacterial origin of various diseases are fully described, as well as the 
bearing of the knowledge so gained upon prevention and cure. The subjects 
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section. 

Methods of diagnosis are given the most minute and careful attention, thus 
enabling the reader to learn the very latest methods of investigation without 
consulting works specially devoted to the subject. 



CONTRIBUTORS ; 



Dr. J. S. Billings, Philadelphia. 
Francis Delafield, New York. 
Reginald H. Fitz, Boston. 
James W. Holland, Philadelphia. 
Henry M. Lyman, Chicago. 
William Osier, Baltimore. 



Dr. William Pepper, Philadelphia. 
W. Gilman Thompson, New York. 
W. H. Welch, Baltimore. 
James T. Whittaker, Cincinnati. 
James C. Wilson, Philadelphia. 
Horatio C. Wood, Philadelphia. 



" We reviewed the first volume of this work, and said : ' It is undoubtedly one of the best 
text-books on the practice of medicine which we possess.' A consideration of the second 
and last volume leads us to modify that verdict and to say that the completed work is, in our 
opinion, the best of its kind it has ever been our fortune to see. It is complete, thorough, 
accurate, and clear. It is well written, well arranged, well printed, well illustrated, and well 
bound. It is a model of what the modern text-book should be."— A>w York Medical yournal. 

" A library upon modern medical art. The work must promote the wider diffusion of 
sound knowledge." — Afnerican ^Lancet. 

" A trusty counsellor for the practitioner or senior student, on which he may implicitly 
rtVf."— Edinburgh Medical journal. 



CATALOGUE OF MEDICAL WORKS. 



For Sale by Subscription, 



AN AMERICAN TEXT-BOOK OF SURGERY. Edited by Wil- 
liam W. Keen, M. D., LL.D., and J. William White, M. D., Ph. D. 
Forming one handsome royal-octavo volume of 1250 pages (10x7 inches), 
with 500 wood-cuts in text, and 37 colored and half-tone plates, many of 
them engraved from original photographs and drawings furnished by the 
authors. Prices : Cloth, ^7.00 net; Sheep or Half- Morocco, j^S.oo net. 

SECOND EDITION, REVISED AND ENLARGED, 
With a Section devoted to '* The Use of the Rbntgen Rays in Surgery." 

The want of a text-book which could be used by the practitioner and at the 
same time be recommended to the medical student has been deeply felt, espe- 
cially by teachers of surgery; hence, when it was suggested to a number of 
these that it would be well to unite in preparing a text-book of this description, 
great unanimity of opinion was found to exist, and the gentlemen below named 
gladly consented to join in its production. While there is no distinctive Amer- 
ican Surgery, yet America has contributed very largely to the progress of modern 
surgery, and among the foremost of those who have aided in developing this art 
and science will be found the authors of the present volume. All of tbem are 
teachers of surgery in leading medical schools and hospitals in the United States 
and Canada. 

Especial prominence has been given to Surgical Bacteriology, a feature which 
is believed to be unique in a surgical text-book in the English language. Asep- 
sis and Antisepsis have received particular attention. The text is brought well 
up to date in such important branches as cerebral, spinal, intestinal, and pelvic 
surgery, the most important and newest operations in these departments being 
described and illustrated. 

The text of the entire book has been submitted to all the authors for their 
mutual criticism and revision — an idea in book-making that is entirely new and 
original. The book as a whole, therefore, expresses on all the important sur- 
gical topics of the day the consensus of opinion of the eminent surgeons who 
have joined in its preparation. 

One of the most attractive features of the book is its illustrations. Very 
many of them are original and faithful reproductions of photographs taken 
directly from patients or from specimens. 

CONTRIBUTORS ; 



Dr. Charles H. Burnett, Philadelphia. 
Phineas S. Conner, Cincinnati. 
Frederic S. Dennis, New York. 
William W. Keen, Philadelphia. 
Charles B. Nancrede, Ann Arbor, Mich. 
Roswell Park, Buffalo, N. Y. 
Lewis S. Pilcher, New York. 



Dr. Nicholas Senn, Chicago, 

Francis J. Shepherd, Montreal, Canada. 

Lewis A. Stimson, New York. 

William Thomson, Philadelphia, 

J. Collins Warren, Boston. 

J. William White, Philadelphia, 



" If this text-book is a fair reflex of the present position of American surgery, we must 
admit it is of a very high order of merit, and that English surgeons will have to look verjl 
carefully to their laurels if they are to preserve a position in the van of surgical practice."— 
London Lancet, 



tV. S. SAUNDERS' 



For Sale by Subscription. 



AN AMERICAN TEXT-BOOK OF GYNECOLOGY, MEDICAL 
AND SURGICAL, for the use of Students and Practitioners. 

Edited by J. M. Baldy, M. D. Forming a handsome royal-octavo volume, 
with 360 illustrations in text and 37 colored and half-tone plates. Prices: 
Cloth, ^6.00 net; Sheep or Half -Morocco, ^7.00 net. 

In this volume all anatomical descriptions, excepting those essential to a clear 
understanding of the text, have been omitted, the illustrations being largely de- 
pended upon to elucidate the anatomy of the parts. This work, which is 
thoroughly practical in its teachings, is intended, as its title implies, to be a 
working text-book for physicians and students. A clear line of treatment has 
been laid down in every case, and although no attempt has been made to dis- 
cuss mooted points, still the most important of these have been noted and ex- 
plained. The operations recommended are fully illustrated, so that the reader, 
having a picture of the procedure described in the text under his eye, cannot fail 
to grasp the idea. All extraneous matter and discussions have been carefully 
excluded, the attempt being made to allow no unnecessary details to cumber 
the text. The subject-matter is brought up to date at every point, and the 
work is as nearly as possible the combined opinions of the ten specialists who 
hgure as the authors. 

The work is well illustrated throughout with wood-cuts, half-tone and 
colored plates, mostly selected from the authors' private collections. 



CONTRIBUTORS : 



Dr. Henry T. Byford. 
John M. Baldy. 
Edwin Cragin. 
J. H. Etheridge. 
William Goodell. 



Dr. Howard A. Kelly. 
Fiorian Krug. 
E. E. Montgomery. 
William R. Pryor. 
George M. Tuttle. 



" The most notable contribution to gynecological literature since 1887 and the most 

complete exponent of gynecology which we have. No subject seems to have been neglected, 
.... and the gynecologist and surgeon, and the general practitioner who has any desire 
to practise diseases of women, will find it of practical value. In the matter of illustrations 
and plates the book surpasses anything we have seen." — Boston Medical and Surgical 
yournal. 

" A valuable addition to the literature of Gynecology. The writers are progressive, 
aggressive, and earnest in their convictions."— A/^^zm/ News, Philadelphia. 

" A thoroughly modern text-book, and gives reliable and well-tempered advice and \n- 
%XxViCX\ovi.."— Edinburgh Medical Journal. 

" The harmony of its conclusions and the homogeneity of its style give it an individuality 
which suggests a single rather than a m\i\xvp\&2i\x\hox%\v\'^''— Annals of Surgery. 

" It must command attention and respect as a worthy representation of our advanced 
clinical tGnching."— A tnerican Journal of Medical Sciences. 



CATALOGUE OF MEDICAL WORKS. 



For Sale by Subscription. 



AN AMERICAN TEXT-BOOK OF THE DISEASES OF CHIL- 
DREN. By American Teachers. Edited by Louis Starr, M. D., 
assisted by Thompson S. Westcott, M. D. In one handsome royal-8va 
volume of 1190 pages, profusely illustrated with wood-cuts, half-tone and 
colored plates. Net Prices : Cloth, $7.00 ; Sheep or Half-Morocco, 38.00. 

The plan of this work embraces a series of original articles written by some 
sixty well-known psediatrists, representing collectively the teachings of the most 
prominent medical schools and colleges of America. The work is intended to 
be a PRACTICAL book, suitable for constant and handy reference by the practi- 
tioner and the advanced student. 

One decided innovation is the large number of authors, nearly every article 
being contributed by a specialist in the linj on which he writes. This, while 
entailing considerable labor upon the editors, has resulted in the publication of 
a work thoroughly new and abreast of the times. 5 

Especial attention has been given to the latest accepted teachings upon the 
etiology, symptoms, pathology, diagnosis, and treatment of the disorders of chil- 
dren, with the introduction of many special formulae and therapeutic procedures. 

Special chapters embrace at unusual length the Diseases of the Eye, Ear, 
Nose and Throat, and the Skin ; while the introductory chapters cover fully the 
important subjects of Diet, Hygiene, Exercise, Bathing, and the Chemistry of 
Food. Tracheotomy, Intubation, Circumcision, and such minor surgical pro- 
cedures coming within the province of the medical practitioner are carefully 
considered. 

CONTRIBUTORS : 

Dr. S. S. Adams, Washington. 

John Ashhiirst, Jr., Philadelphia. 
A. D. Blackader, Montreal, Canada. 
Dillon Brown. New York. 



Edward M. Buckingham, Boston. 
Charles W. Burr, Philadelphia. 
W. E. Casselberry, Chicago. 
Henry Dwight Chapin, New York. 
W. S. Christopher, Chicago. 
Archibald Church, Chicago. 
Floyd M. Crandall, New York. 
. Andrew F. Currier, New York. 
Roland G. Curtin, Philadelphia 
J. M. DaCosta, Philadelphia. 
1. N. Danforth, Chicago. 
Edward P. Davis, Philadelphia, 
John B. Deaver, Philadelphia. 
G. E. de Schweinitz, Philadelphia. 
John Doming, New York. 
Charles Warrington Earle, Chicago. 
Wm. A. Edwards, San Diego, Cal. 
F. Forchheimer, Cincinnati. 
J. Henry Fruitnight, New York. 
Landon Carter Gray, New York. 
J. P. Crozer Griffith. Philadelphia. 
W. A. Hardaway. St. Louis. 
M. P Hatfield, Chicago. 
Barton Cooke Hirst, Philadelphia. 
H. Illoway, Cincinnati. 
Henry Jackson, Boston. 
Charles G. Jennings, Detroit. 
Henry Koplik, New York. 



Dr. Thomas S. Latimer, Baltimore. 
Albert R. Leeds, Hoboken, N. J. 
J. Hendrie Lloyd, Philadelphia. 
George Roe Lockwood, New York. 
Henry M. Lyman, Chicago. 
Francis T. Miles, Baltimore. 
Charles K. Mills, Philadelphia. 
John H. Musser, Philadelphia. 
Thomas R. Neilson, Philadelphia. 
W. P. Northrup, New York. 
William Osier, Baltimore. 
Frederick A. Packard, Philadelphia. 
William Pepper, Philadelphia. 
Frederick Peterson, New York. 
W. T. Plant, Syracuse, New York. 
William M. Powell, Atlantic City. 
B. Alexander Randall, Philadelphia. 
Edward O. Shakespeare, Philadelphia 
F. C. Shattuck, Boston. 
J. Lewis Smith, New York. 
Louis Starr, Philadelphia. 
M. Allen Starr, New York. 
J. Madison Taylor, Philadelphia. 
Charles W. Townsend, Boston. 
James Tyson, Philadelphia. 
W. S. Thayer, Baltimore. 
Victor C. Vaughan, Ann Arbor, Mich 
Thompson S. Westcott, Philadelphia. 
Henry R. Wharton, Philadelphia. 
J. William Whhe, Philadelphia. 



C. Wilson, Philadelphia, 



10 W. B. SAUNDERS' 



A NEW PRONOUNCING DICTIONARY OF MEDICINE, with 
Phonetic Pronunciation, Accentuation, Etymology, etc. By John 
M. Keating, M. D., LL.D,, Fellow of the College of Physicians of Phila- 
delphia ; Vice-President of the American Paediatric Society ; Ex-President 
of the Association of Life Insurance Medical Directors ; Editor " Cyclo- 
paedia of the Diseases of Children," etc. ; and Henry Hamilton, author 
of " A New Translation of Virgil's ^Eneid into English Rhyme ;" co- 
author of " Saunders' Medical Lexicon," etc, ; with the Collaboration of 
J. Chalmers DaCosta, M. D., and Frederick A. Packard, M. D. 
With an Appendix containing important Tables of Bacilli, Micrococci, 
Leucomaines, Ptomaines, Drugs and Materials used in Antiseptic Sur- 
gery, Poisons and their Antidotes, Weights and Measures, Thermometric 
Scales, New Official and Unofficial Drugs, etc. One very attractive volume 
of over 800 pages. Second Revised Edition, Prices: Cloth, ^5.00 net ; 
Sheep ^or Half-Morocco, ^6.00 net ; with Denison's Patent Ready- Refer- 
ence Index ; without patent index, Cloth, $4.00 net ; Sheep or Half- 
Morocco, ^5.00 net. 

PROF£SSIO?rAI. OPIXIOXS. 

" I am much pleased with Keating's Dictionary, and shall take pleasure in recommending 
it to my classes." 

Henry M. Lyman, M. D., 
Professor of Principles and Practice of Medicine, Rush Medical College, Chicago, III. 

" I am convinced that it will be a very valuable adjunct to my study-table, convenient in 
size and sufficiently full for ordinary use." 

C. A. LiNDSLEY, M. D., 
Professor of Theory and Practice of Medicine, Medical Dept. Yale University: 

Secretary Connecticut State Board of Health, New Haven, Conn, 



AUTOBIOGRAPHY OF SAMUEL D. GROSS, M. D., Emeritus Pro- 
fessor of Surgery in the Jefferson Medical College of Philadelphia, with 
Reminiscences of His Times and Contemporaries. Edited by his sons, 
Samuel W. Gross, M. D., LL.D,, late Professor of Principles of Surgery 
and of Clinical Surgery in the Jefferson Medical College, and A, Haller 
Gross, A. M,, of the Philadelphia Bar. Preceded by a Memoir of Dr. 
Gross, by the late Austin Flint, M. D., LL.D. In two handsome volumes, 
each containing over 400 pages, demy 8vo, extra cloth, gilt tops, with fine 
Frontispiece engraved on steel. Price per Volume, $2.50 net 
This autobiography, which was continued by the late eminent surgeon until 
within three months of his death, contains a full and accurate history of his 
early struggles, trials, and subsequent successes, told in a singularly interesting 
and charming manner, and embraces short and graphic pen-portraits of many 
of the most distinguished men — surgeons, physicians, divines, lawyers, states- 
men, scientists, etc. — with whom he was brought in contact in America and in 
Europe ; the whole forming a retrospect of more than three-quarters of a century. 



1 



CATALOGUE OF MEDICAL WORKS. II 

SURGICAL PATHOLOGY AND THERAPEUTICS. By John 
Collins Warren, M. D., LL.D., Professor of Surgery, Medical Depart- 
ment Harvard University ; Surgeon to the Massachusetts General Hospital, 
etc. A handsome octavo volume of 832 pages, with 136 relief and litho- 
graphic illustrations, 33 of vi^hich are printed in colors, and all of which 
were drawn by William J. Kaula from original specimens. Prices : Cloth, 
$6,00 net; Half- Morocco, ^7.00 net. 

" The volume is for the bedside, the amphitheatre, and the ward. It deals 
with things not as we see them through the microscope alone, but as the prac- 
titioner sees their effect in his patients ; not only as they appear in and affect 
culture-media, but also as they influence the human body ; and, following up 
the demonstrations of the nature of diseases, the author points out their logical 
treatment." i^New York Medical yournal). " It is the handsomest specimen 
of book-making * -5^ -3^ that has ever been issued from the American medical 
press " {American Journal of the Medical Sciences, Philadelphia). 

Without Exception, the Illustrations are the Best ever Seen in a 
"Work of this Kind. 

"A most striking and very excellent feature of this book is its illustrations. Without ex- 
ception, from the point of accuracy and artistic merit, they are the best ever seen in a work 
of this kind. * * * Many of those representing microscopic pictures are so perfect in their 
coloring and detail as almost to give the beholder the impression that he is looking down the 
barrel of a microscope at a well-mounted section. " — Annals of Surgery, Philadelphia. 

PATHOLOGY AND SURGICAL TREATMENT OF TUMORS. 

By N. Senn, M. D., Ph. D., LL. D., Professor of Practice of Surgery and 
of Clinical Surgery, Rush Medical College ; Professor of Surgery, Chicago 
Polyclinic ; Attending Surgeon to Presbyterian Hospital ; Surgeon-in-Chief, 
St. Joseph's Hospital, Chicago. One volume of 710 pages, with 515 
engravings, including full-page colored plates. Prices: Cloth, ;^6.oo netj 
Half-Morocco, ;^7.oo net. 

Books specially devoted to this subject are few, and in our text-books and 
systems of surgery this part of surgical pathology is usually condensed to a de- 
gree incompatible with its scientific and clinical importance. The author spent 
many years in collecting the material for this work, and has taken great pains 
to present it in a manner that should prove useful as a text-book for the student, 
a work of reference for the busy practitioner, and a reliable, safe guide for the 
surgeon. The more difficult operations are fully described and illustrated. More 
than one hundred of the illustrations are original, while the remainder were 
selected from books and medical journals not readily accessible. 

" The most exhaustive of any recent book in English on this subject. It is well illus- 
trated, and will doubtless remain as the principal monograph on the subject in our language 
for some years. The book is handsomely illustrated and printed, .... and the author has 
given a notable and lasting contribution to ^wx^try ." —yournal of American Medical Asso- 
ciation, Chicago. 



12 W. B. SAUNDERS' 



MEDICAL DIAGNOSIS. By Dr. Oswald Vierordt, Professor of 
Medicine at the University of Heidelberg. Translated, with additions, 
from the Second Enlarged German Edition, with the author's permission, 
by Francis H. Stuart, A. M., M. D. Third and Revised Edition. In 
one handsome royal-octavo volume of 700 pages, 178 fine wood-cuts in 
text, many of which are in colors. Prices : Cloth, ^4.00 net ; Sheep or 
Half-Morocco, $5.00 net. 

In this work, as in no other hitherto published, are given full and accurate 
explanations of the phenomena observed at the bedside. It is distinctly a clin- 
ical work by a master teacher, characterized by thoroughness, fulness, and accu- 
racy. It is a mine of information upon the points that are so often passed over 
without explanation. Especial attention has been given to the germ-theory as a 
factor in the origin of disease. 

This valuable work is now published in German, English, Russian, and 
Italian. The issue of a third American edition within two years indicates the 
favor with which it has been received by the profession. 

THE PICTORIAL ATLAS OF SKIN DISEASES AND SYPHI- 
LITIC AFFECTIONS. (American Edition.) Translation from 
the French. Edited by J. J. Pringle, M. B., F. R. C. P., Assistant Phy- 
sician to, and Physician to the department for Diseases of the Skin at, the 
Middlesex Hospital, London. Photo-lithochromes from the famous models 
of dermatological and syphilitic cases in the Museum of the Saint-Louis 
Hospital, Paris, with explanatory wood -cuts and letter-press. In 12 Parts, 
at ^3.00 per Part. Parts i to 8 now ready. 

"The plates are beautifully executed."— Jonathan Hutchinson, M. D. (London 
Hospital). 

"The plates in this Atlas are remarkably accurate and artistic reproductions o^ typical 
examples of skin disease. The work will be of great value to the practitioner and student." 
— William Anderson, M. D. (St. Thomas Hospital). 

" If the succeeding parts of this Atlas are to be similar to Part i, now before us, we have 
no hesitation in cordially recommending it to the favorable notice of our readers as one of 
the finest dermatological atlases with which we are acquainted." — Glasgow Medical jfournal , 
Aug., 1895. 

" Of all the atlases of skin diseases which have been published in recent years, the present 
one promises to be of greatest interest and value, especiallj' from the standpoint of the 
general practitioner." — American Medico-Surgical Bulletin, Feb. 22, 1896. 

" The introduction of explanatory' wood-cuts in the text is a novel and most important 
feature which greatly furthers the easier understanding of the excellent plates, than which 
nothing, we venture to say, has been seen better in point of correctness, beauty, and general 
merit." — Neiv York Medical Journal, Feb. 15, 1896. 

" An interesting feature of the Atlas is the descriptive text, \^hich is written for each picture 
by the physician who treated the case or at whose instigation the models have been made. 
We predict for this truly beautiful work a large circulation in all parts of the medical world 
where the names St. Louis and Baretta have preceded it." — Medical Record, N. Y., Feb. i, 
1896. 



CATALOGUE OF MEDICAL WORKS. 1 3 

PRACTICAL POINTS IN NURSING. For Nurses in Private 
Practice. By Emily A. M. Stoney, Graduate of the Training-School 
for Nurses, Lawrence, Mass. ; Superintendent of the Training-School for 
Nurses, Carney Hospital, South Boston, Mass. 456 pages, handsomely 
illustrated with 73 engravings in the text, and 9 colored and half-tone 
plates. Cloth. Price, ^1.75 net. 

SECOND EDITION, THOROUGHLY REVISED. 

In this volume the author explains, in popular language and in the shortest 
possible form, the entire range oi private nursing as distinguished from hospital 
nursing, and the nurse is instructed how best to meet the various emergencies of 
medical and surgical cases when distant from medical or surgical aid or when 
thrown on her own resources. 

An especially valuable feature of the work w^ill be found in the directions to 
the nurse how to if?iprovise everything ordinarily needed in the sick-room, where 
the embarrassment of the nurse, owing to the want of proper appliances, is fre- 
quently extreme. 

The work has been logically divided into the following sections : 

I. The Nurse : her responsibilities, qualifications, equipment, etc. 
II, The Sick-Room : its selection, preparation, and management. 

III. The Patient : duties of the nurse in medical, surgical, obstetric, and gyne- 

cologic cases. 

IV. Nursing in Accidents and Emergencies. 
V, Nursing in Special Medical Cases. 

VI. Nursing of the New-born and Sick Children. 
VII. Physiology and Descriptive Anatomy, 

The Appendix contains much information in compact form that will be found 
of great value to the nurse, including Rules for Feeding the Sick ; Recipes for 
Invalid Foods and Beverages ; Tables of Weights and Measures ; Table for 
Computing the Date of Labor; List of Abbreviations ; Dose-List; and a full 
and complete Glossary of Medical Terms and Nursing Treatment, 

"This is a well-written, eminently practical volume, which covers the entire range of 
private nursing as distinguished from hospital nursing, and instructs the nurse how best to 
meet the various emergencies which may arise and how to prepare everything ordinarily 
needed in the illness of her -p^Uftnt." —American Journal of Obstetrics and Diseases of 
Women and Children, Aug., 1896. 

A TEXT-BOOK OF BACTERIOLOGY, including the Etiology and 
Prevention of Infective Diseases and an account of Yeasts and Moulds, 
Hsematozoa, and Psorosperms, By Edgar M. Crookshank, M. B., Pro- 
fessor of Comparative Pathology and Bacteriology, King's College, London. 
A handsome octavo volume of 700 pages, with 273 engravings in the text, 
and 22 original and colored plates. Price, ^6,50 net. 

This book, though nominally a Fourth Edition of Professor Crookshank's 
" Manual of Bacteriology," is practically a new work, the old one having 
been reconstructed, greatly enlarged, revised throughout, and largely rewritten, 
forming a text-book for the Bacteriological Laboratory, for Medical Ofhcers of 
Health, and for Veterinary Inspectors. 



14 fV. B. SAUNDERS' 



A TEXT-BOOK OF HISTOLOGY, DESCRIPTIVE AND PRAC- 
TICAL. For the Use of Students. By Arthur Clarkson, M. B., 
C. M., Edin., formerly Demonstrator of Physiology in the Owen's College, 
Manchester; late Demonstrator of Physiology in the Yorkshire College, 
Leeds. Large 8vo, 554 pages, with 22 engravings in the text, and 174 
beautifully colored original illustrations. Price, strongly bound in Cloth, 
^6.00 net. 

The purpose of the writer in this work has been to furnish the student of His- 
tology, in one volume, with both the descriptive and the practical part of the 
science. The first two chapters are devoted to the consideration of the general 
methods of Histology ; subsequently, in each chapter, the structure of the tissue 
or organ is first systematically described, the student is then taken tutorially over 
the specimens illustrating it, and, finally, an appendix affords a short note, of the 
methods of preparation. 

"We would most cordially recommend it to all students of histology." — Dublin Medical 
Journal. 

"It is pleasant to give unqualified praise to the colored illustrations ; . . . the standard is 
high, and many of them are not only extremely beautiful, but very clear and demonstra- 
tive. . . . The plan of the book is excellent." — Liverpool Medical jfournal. 

ARCHIVES OF CLINICAL SKIAGRAPHY. By Sydney Rowland, 
B. A., Camb. A series of collotype illustrations, with descriptive text, 
illustrating the applications of the New Photography to Medicine and Sur- 
gery. Price, per Part, ^i.oo. Parts I. to V. now ready. 

The object of this publication is to put on record in permanent fonn some of 
the most striking applications of the new photography to the needs of Medicine 
and Surgery. 

The progress of this new art has been so rapid that, although Prof. Rontgen's 
discovery is only a thing of yesterday, it has already taken its place among the 
approved and accepted aids to diagnosis. 

WATER AND WATER SUPPLIES. By John C. Thresh, D. Sc, 
M. B., D. P. H., Lecturer on Public Health, King's College, London; 
Editor of the "Journal of State Medicine," etc. i2mo, 438 pages, illus- 
trated. Handsomely bound in Cloth, with gold side and back stamps. 
Price, ^2.25 net. 

This work will furnish any one interested in public health the information 
requisite for forming an opinion as to whether any supply or proposed supply 
is sufficiently wholesome and abundant, and whether the cost can be considered 
reasonable. 

The work does not pretend to be a treatise on Engineering, yet it contains 
sufficient detail to enable any one who has studied it to consider intelligently any 
scheme which may be submitted for supplying a community with water. 



CATALOGUE OF MEDICAL WORKS. 1 5 

DISEASES OF THE EYE. A Hand-Book of Ophthalmic Prac- 
tice. By G. E. DE ScHWEiNiTZ, M. D., Professor of Ophthalmology in 
the Jefferson Medical College, Philadelphia, etc. A handsome royal- 
octavo volume of 679 pages, with 256 fine illustrations, many of which are 
original, and 2 chromo-lithographic plates. Prices : Cloth, ^^4.00 net ; 
Sheep or Half-Morocco, $5.00 net. 

The object of this work is to present to the student, and to the practitioner 
who is beginning work in the fields of ophthalmology, a plain description of the 
optical defects and diseases of the eye. To this end special attention has been 
paid to the clinical side of the question ; and the method of examination, the 
symptomatology leading to a diagnosis, and the treatment of the various ocular 
defects have been brought into prominence. 

SECOND EDITION, REVISED AND GREATLY ENLARGED. 

The entire book has been thoroughly revised. In addition to this general 
revision, special paragraphs on the following new matter have been introduced : 
Filamentous Keratitis, Blood-staining of the Cornea, Essential Phthisis Bulbi, 
Foreign Bodies in the Lens, Circinate Retinitis, Symmetrical Changes at the 
Macula Lutea in Infancy, Hyaline Bodies in the Papilla, Monocular Diplopia, 
Subconjunctival Injections of Germicides, Infiltration-Anaesthesia, and Steriliza- 
tion of Collyria. Brief mention of Ophthalmia Nodosa, Electric Ophthalmia, 
and Angioid Streaks in the Retina also finds place. An Appendix has been 
added, containing a full description of the method of determining the corneal 
astigmatism with the ophthalmometer of Javal and Schiotz, and the rotations 
of the eyes with the tropometer of Stevens, The chapter on Operations has 
been enlarged and rewritten. 

" A clearly written, comprehensive manual. . . . One which we can commend to students 
as a reliable text-book, written with an evident knowledge of the wants of those entering upon 
the study of this special branch of medical scx^nce."— British Medical Journal. 

" The work is characterized by a lucidity of expression which leaves the reader in no 
doubt as to the meaning of the language employed. . . . We know of no work in which 
these diseases are dealt with more satisfactorily, and indications for treatment more clearly 
given, and in harmony with the practice of the most advanced ophthalmologists." — Mari- 
time Medical News. 

" It is hardly too much to say that for the student and practitioner beginning the study of 
Ophthalmology, it is the best single volume at present published." — Medical News. 

" The latest and one of the best books on Ophthalmology. The book is thoroughly up to 
date, and is certainly a work which not only commends itself to the student, but is a ready 
reference for the busy practitioner." — International Medical Review. 

PROFESSIONAL. OPINIOJfS. 

"A work that will meet the requirements not only of the specialist, but of the general 
practitioner in a rare degree. I am satisfied that unusual success awaits it." 

William Pepper, M. D. 
Provost and Professor of Theory and Practice of Medicine and Clinical Medicine 
in the University of Pennsylvania. 

*' ConUins in concise and reliable form the accepted views of Ophthalmic Science." 

William Thomson, M. D., 
Professor of Ophthalmology, fefferson Medical College, Philadelphia, Pa. 



1 6 IV. B. SAUNDERS' 



TEXT-BOOK UPON THE PATHOGENIC BACTERIA. Spe- 
cially written for Students of Medicine. By Joseph McFarland, 
M. D., Professor of Pathology and Bacteriology in the Medico-Chirurgical 
College of Philadelphia, etc. 359 pages, finely illustrated. Price, Cloth, 
^552.50 net. 

The book presents a concise account of the technical procedures necessary in 
the study of Bacteriology. It describes the life-history of pathogenic bacteria, and 
the pathological lesions following invasion. 

The work is intended to be a text-book for the medical student and for the 
practitioner who has had no recent laboratory training in this department of medi- 
cal science. The instructions given as to needed apparatus, cultures, stainings, 
microscopic examinations, etc., are ample for the student's needs, and will afford 
to the physician much information that will interest and profit him relative to a 
subject which modern science shows to go far in explaining the etiology of many 
diseased conditions. 

The illustrations have been gathered from standard sources, and comprise the 
best and most complete aggregation extant. 

" It is excellently adapted for the medical students and practitioners for whom it is avowedly 
written. . . . The descriptions given are accurate and readable, and the book should prove 
useful to those for whom it is written. — London Lancet, Aug. 29, 1896. 

" The author has succeded admirably in presenting the essential details of bacteriological 
technics, together with a judiciously chosen summary of our present knowledge of pathogenic 
bacteria. . . . The work, we think, should have a wide circulation among English-speaking 
students of medicine." — N. Y. Medical Joicrnal , April 4, 1896. 

" The book will be found of considerable use by medical men who have not had a special 
bacteriological training, and who desire to understand this important branch of medical 
science." — Edinburgh Medical Journal, July, 1896. 

LABORATORY GUIDE FOR THE BACTERIOLOGIST. By 

Langdon Frothingham, M. D. V., Assistant in Bacteriology and Veteri- 
nary Science, Sheffield Scientific School, Yale University. Illustrated. 
Price, Cloth, 75 cents. 

The technical methods involved in bacteria-culture, methods of staining, and 
microscopical study are fully described and arranged as simply and concisely as 
possible. The book is especially intended for use in laborator}' work 

" It is a convenient and useful little work, and will more than repay the ouday necessary 
for its purchase in the saving of time which would otherwise be consumed in looking up the 
various points of technique so clearly and concisely laid down in its pages." — American Med.- 
Surg. Bulletin. 

FEEDING IN EARLY INFANCY. By Arthur V. Meigs, M. D. 
Bound in limp cloth, flush edges. Price, 25 cents net. 

Synopsis : Analyses of Milk — Importance of the Subject of Feeding in Early 
Infancy — Proportion of Casein and Sugar in Human Milk — Time to Begin Arti- 
ficial Feeding of Infants — Amount of Food to be Administered at Each Feed- 
ing — Intervals between Feedings — Increase in Amount of Food at Different 
Periods of Infant Development — Unsuitableness of Condensed Milk as a Sub- 
stitute for Mother's Milk — Objections to Sterilization or "Pasteurization" of 
Milk — Advances made in the Method of Artificial Feeding of Infants. 



CATALOGUE OF MEDICAL W.ORKS. ly 

ESSENTIALS OF ANATOMY AND MANUAL OF PRACTI- 
CAL DISSECTION, containing " Hints on Dissection " By Charles 
B, Nancrede, M. D., Professor of Surgery and Clinical Surgery in the 
University of Michigan, Ann Arbor; Corresponding Member of the Royal 
Academy of Medicine, Rome, Italy ; late Surgeon Jefferson Medical Col- 
lege, etc. Fourth and revised edition. lost 8vo, over 500 pages, with 
handsome full-page lithographic plates in colors, and over 200 illustrations. 
Price : Extra Cloth or Oilcloth for the dissection-room, ;^2.oo net. 

Neither pains nor expense has been spared to make this vi'ork the most ex- 
haustive yet concise Student's Manual of Anatomy and Dissection ever pub- 
lished, either in America or in Europe. 

The colored plates are designed to aid the student in dissecting the muscles, 
arteries, veins, and nerves. The wood-cuts have all been specially drawn and 
engraved, and an Appendix added containing 60 illustrations representing the 
structure of the entire human skeleton, the whole being based on the eleventh 
edition of Gray's Anatomy, 



"The plates are of more than ordinary excellence, and are of especial value to students in 
their work in the dissecting-room."— y<?»rMa/ 0/ American Medical Association. 

"Should be in the hands of every medical student." — Cleveland Medical Gazette. 

" A concise and judicious work." — Buffalo Medical and Surgical Journal. 

A MANUAL OF PRACTICE OF MEDICINE. By A. A. Stevens, 
A. M., M. D., Instructor of Physical Diagnosis in the University of Penn- 
sylvania, and Demonstrator of Pathology in the Woman's Medical College 
of Philadelphia. Specially intended for students preparing for graduation 
and hospital examinations, and includes the following sections : General 
Diseases, Diseases of the Digestive Organs, Diseases of the Respiratory 
System, Diseases of the Circulatory System, Diseases of the Nervous Sys- 
tem, Diseases of the Blood, Diseases of the Kidneys, and Diseases of the 
Skin. Each section is prefaced by a chapter on General Symptomatology. 
Post 8vo, 512 pages. Numerous illustrations and selected formulae. 
Price, $2.50. Bound in flexible leather. 

FOURTH EDITION, REVISED AND ENLARGED. 

Contributions to the science of medicine have poured in so rapidly during the 
last quarter of a century that it is well-nigh impossible for the student, with the 
limited time at his disposal, to master elaborate treatises or to cull from them 
that knowledge which is absolutely essential. From an extended experience in 
teaching, the author has been enabled, by classification, to group allied symp- 
toms, and by the judicious elimination of theories and redundant explanations 
to bring within a comparatively small compass a complete outline of the prac- 
tice of medicine. 



1 8 IV. B. SAUNDERS 



yiP^^Xiia. OF MATERIA MEDICA AND THERAPEUTICS. 

By A. A. Stevens, A. M., M. D., Instructor of Physical Diagnosis in the 
University of Pennsylvania, and Demonstrator of Pathology in the Woman's 
Medical College of Philadelphia. 445 pages. Price, Cloth, j^2.25. 

SECOND EDITION, REVISED. 

This wholly new volume, which is based on the last edition of the Pharma- 
copceia, comprehends the following sections : Physiological Action of Drugs ; 
Drugs; Remedial Measures other than Drugs; Applied Therapeutics ; Incom- 
patibility in Prescriptions; Table of Doses; Index of Drugs; and Index of 
Diseases ; the treatment being elucidated by more than two hundred formulae. 

" The author is to be congratulated upon having presented the medical student with as 
accurate a manual of therapeutics as it is possible to ^re^dirQ."— Therapeutic Gazette. 

*' Far superior to most of its class ; in fact, it is very good. Moreover, the book is reliable 
and accurate." — New York Medical Journal. 

" The author has faithfully presented modern therapeutics in a comprehensive work, . . . 
and it will be found a reliable ^xAe."— University Medical Magazine. 



NOTES ON THE NEWER REMEDIES: their Therapeutic Ap- 
plications and Modes of Administration. By David Cerna, M. D., 
Ph. D., Demonstrator of and Lecturer on Experimental Therapeutics in 
the University of Pennsylvania. Post-octavo, 253 pages. Price, $1.25. 

SECOND EDITION, RE-WRITTEN AND GREATLY ENLARGED. 

The work takes up in alphabetical order all the newer remedies, giving their 
physical properties, solubility, therapeutic applications, administration, and 
chemical formula. 

It thus forms a very valuable addition to the various works on therapeutics 
now in existence. 

Chemists are so multiplying compounds, that., if each compound is to be thor- 
oughly studied, investigations must be carried far enough to determine the prac- 
^ tical importance of the new agents. 

" Especially valuable because of its completeness, its accuracy, its systematic consider- 
ation of the properties and therapy of many remedies of which doctors generally know but 
little, expressed in a brief yet terse manner." — Chicago Clinical Review. 



TEMPERATURE CHART. Prepared by D. T. Laine, M. D. Size 
8x 13^ inches. Price, per pad of 25 charts, 50 cents. 

A conveniently arranged chart for recording Temperatm-e, with columns for 
daily amounts of Urinary and Fecal Excretions, Food, Remarks, etc. On the 
back of each chart is given in full the method of Brand in the treatment of 
Typhoid Fever. 



CATALOGUE OF MEDICAL WORKS. I9 

SAUNDERS' POCKET MEDICAL LEXICON ; or, Dictionary of 
Terms and Words used in Medicine and Surgery. By John M. 
Keating, M. D., editor of " Cyclopaedia of Diseases of Children," etc. ; 
author of the " New Pronouncing Dictionary of Medicine;" and Henr\ 
Hamilton, author of " A New Translation of Virgil's ^neid into Eng- 
lish Verse;" co-author of a " New Pronouncing Dictionaiy of Medicine." 
A new and revised edition. 32010, 282 pages. Prices: Cloth, 75 centsj 
Leather Tucks, jSJi.oo. 

This new and comprehensive work of reference is the outcome of a demand 
for a more modern handbook of its class than those at present on the market, 
which, dating as they do from 1855 ^o 1884, are of but trifling use to the student 
by their not containing the hundreds of new words now used in current litera- 
ture, especially those relating to Electricity and Bacteriology. 

" Remarkably accurate in terminology, accentuation, and A^iixnxXoxx."— Journal of Amer" 
ican Medical Association. 

" Brief, yet complete .... it contains the very latest nomenclature in even the newest 
departments of medicine." — New York Medical Record. 



SAUNDERS' POCKET MEDICAL FORMULARY. By William 
M. Powell, M. D., Attending Physician to the Mercer House for Invalid 
Women at Atlantic City. Containing 1750 Formulas, selected from several 
hundred of the best-known authorities. Forming a handsome and con- 
venient pocket companion of nearly 300 printed pages, with blank leaves 
for Additions ; with an Appendix containing Posological Table, Formulae 
and Doses for Hypodermatic Medication, Poisons and their Antidotes, 
Diameters of the Pemale Pelvis and Foetal Head, Obstetrical Table, Diet 
List for Various Diseases, Materials and Drugs used in Antiseptic Surgery, 
Treatment of Asphyxia from Drowning, Surgical Remembrancer, Tables 
of Incompatibles, Eruptive Fevers, Weights and Measures, etc. Third 
edition, revised and greatly enlarged. Handsomely bound in morocco, 
with side index, wallet, and flap. Price, i^i.75 net. 

A concise, clear, and correct record of the many hundreds of famous formulae 
which are found scattered through the works of the most eminent physicians 
and surgeons of the world. The work is helpful to the student and practitioner 
alike, as through it they become acquainted with numerous formulae which are 
not found in text-books, but have been collected from among the rising genera- 
tion of the profession, college professors, and hospital physicians and surgeons. 

" This little book, that can be conveniently carried in the pocket, contains an immense 
amount of material. It is very useful, and as the name of the author of each prescription is 
given is unusually reliable." — New York Medical Record. 

" Designed to be of immense help to the general practitioner in the exercise of his daily 
calling." — Boston Medical and Surgical Journal. 



20 W. B. SAUNDERS' 



DISEASES OF WOMEN. By Henry J. Garrigues, A.M., M. D., 
Professor of Gynecology and Obstetrics in the New York School of Clinical 
Medicine; Gynecologist to St. Mark's Hospital and to the German Dis- 
pensary, New York City. In one handsome octavo volume of 728 pages, 
illustrated by 335 engravings and colored plates. Prices : Cloth, ^4.00 net; 
Sheep or Half Morocco, I^S.cx) net. 

A PRACTICAL work on gynecology for the use of students and practitioners, 
written in a terse and concise manner. The importance of a thorough know- 
ledge of the anatomy of the female pelvic organs has been fully recognized by 
the author, and considerable space has been devoted to the subject. The chap- 
ters on Operations and on Treatment are thoroughly modern, and are based 
upon the large hospital and private practice of the author. The text is eluci- 
dated by a large number of illustrations and colored plates, many of them being 
original, and forming a complete atlas for studying embryology and the anatomy 
of \}i\Q female genitalia, besides exemplifying, whenever needed, morbid condi- 
tions, instruments, apparatus, and operations. 

Second Edition, Thoroughly Revised, 

The first edition of this work met with a most appreciative reception by the 
medical press and profession both in this country and abroad, and was adopted 
as a text-book or recommended as a book of reference by nearly one hundred 
colleges in the United States and Canada. The author has availed himself of 
the opportunity afforded by this revision to embody the latest approved advances 
in the treatment employed in this important branch of Medicine. He has also 
more extensively expressed his own opinion on the comparative value of the 
different methods of treatment employed. 

"One of the best text-books for students and practitioners which has been published in 
the English language; it is condensed, clear, and comprehensive. The profound learning 
and great clinical experience of the distinguished author find expression in this book in a 
most attractive and instructive form. Young practitioners, to whom experienced consultants 
may not be available, will find in this book invaluable counsel and help." 

Thad. a. Reamy, M. D., LL.D., 
Professor of Clinical Gynecology, Medical College of Ohio : Gynecologist to the Good 
Samaritan and Cincinnati Hospitals. 



A SYLLABUS OF GYNECOLOGY, arranged in conformity witli 
"An American Text-Book of Gynecology." By J. W. Long, M. D., 
Professor of Diseases of Women and Children, Medical College of Vir- 
ginia, etc. Price, Cloth (interleaved), $1.00 net. 

Based upon the teaching and methods laid down in the larger work, this will 
not only be useful as a supplementary volume, but to those who do not already 
possess the text-book it will also have an independent value as an aid to the 
practitioner in gynecological work, and to the student as a guide in the lecture- 
room, as the subject is presented in a manner at once systematic, clear, succinct, 
pnd practical. 



CATALOGUE OF MEDICAL WORKS. 



A MANUAL OF PHYSIOLOGY, with Practical Exercises. For 
Students and Practitioners. By G. N. Stewart, M. A., M. D., D. Sc, 
lately Examiner in Physiology, University of Aberdeen, and of the New 
Museums, Cambridge University ; Professor of Physiology in the Western 
Reserve University, Cleveland, Ohio. Handsome octavo volume of 800 
pages, with 278 illustrations in the text, and 5 colored plates. Price, 
Cloth, ^3.50 net. 

" It will make its way by sheer force of merit, and amply deserves to do so. It is one oj 
the very best English text-books on the subject." — London Lancet. 

" or the many text-books of physiology published, we do not know of one that so nearly 
comes up to the ideal as does Professor Stewart's volume." — Bi-itish Medical Journal. 

ESSENTIALS OF PHYSICAL DIAGNOSIS OF THE THORAX. 

By Arthur M. Corwin, A. M., M. D., Demonstrator of Physical Diagno- 
sis in the Rush Medical College, Chicago; Attending Physician to the 
Central Free Dispensary, Department of Rhinology, Laryngology, and 
Diseases of the Chest. 200 pages. Illustrated. Cloth, flexible covers. 
Price, ^1.25 net. 

SYLLABUS OF OBSTETRICAL LECTURES in the Medical 
Department, University of Pennsylvania. By Richard C. Norris, 
A. M., M. D., Lecturer on Clinical and Operative Obstetrics, University 
of Pennsylvania. Third edition, thoroughly revised and enlarged. Crown 
8vo. Price, Cloth, interleaved for notes, ^2.00 net. 

" This work is so far superior to others on the same subject that we take pleasure in call- 
ing attention briefly to its excellent features. It covers the subject thoroughly, and will 
prove invaluable both to the student and the practitioner. The author has introduced a 
number of valuable hints which would only occur to one who was himself an experienced 
teacher of obstetrics. The subject-matter is clear, forcible, and modern. We are especially 
pleased with the portion devoted to the pmclical duties of the accoucheur, care of the child, 
etc. The paragraphs on antiseptics are admirable; there is no doubtful tone in the direc- 
tions given. No details are regarded as unimportant; no minor matters omitted. We ven- 
ture 10 say that even the old practitioner will find useful hints in this direction which he can- 
not afford to despise." — New York Medical Record. 

A SYLLABUS OF LECTURES ON THE PRACTICE OF SUR- 
GERY, arranged in conformity with " An American Text-Book 
of Surgery." By N. Senn, M. D., Ph. D., Professor of Surgeiy in Rush 
Medical College, Chicago, and in the Chicago Polyclinic. Price, ^2.00. 

This, the latest work of its eminent author, himself one of the contributors 
to " An American Text-Book of Surgery," will prove of exceptional value to 
the advanced student who has adopted that work as his text-book. It is not 
only the syllabus of an unrivalled course of surgical practice, but it is also an 
epitome of or supplement to the larger work. 

" The author has evidently spared no pains in making his Syllabus thoroughly comprehen- 
sive, and har. added new matter and alluded to the most recent authors and operations. Full 
references are also given to all requisite details of surgical anatomy and pathology." — British 
Medical Journal, London. 



22 W. B. SAUNDERS' 



AN OPERATION BLANK, with Lists of Instruments, etc. re- 
quired in Various Operations. Prepared by W. W. Keen, M. D., 
LL.D., Professor of Principles of Surgery in the Jefferson Medical Col- 
lege, Philadelphia. Price per Pad, containing Blanks for fifty operations, 
50 cents net, 

SECOND EDITION, REVISED FORM. 

A convenient blank, suitable for all operations, giving complete instructions 
regarding necessary preparation of patient, etc., with a full list of dressings and 
medicines to be employed. 

On the back of each blank is a list of instruments used — viz. general instru- 
ments, etc., required for all operations ; and special instruments for surgery of 
the brain and spine, mouth and throat, abdomen, rectum, male and female 
genito-urinary organs, the bones, etc. 

The whole forming a neat pad, arranged for hanging on the wall of a sur- 
geon's office or in the hospital operating-room. 

" Will serve a useful purpose for the surgeon in reminding him of the details of prepa- 
ration for the patient and the room as well as for the instruments, dressings, and antiseptics 
needed " — New York Medical Record 

" Covers about all that can be needed in any operation." — American Lancet. 

" The plan is a capital one."— Boston Medical and Surgical Journal. 

LABORATORY EXERCISES IN BOTANY. By Edson S. Bastin, 
M. A., Professor of Materia Medica and Botany in the Philadelphia Col- 
lege of Pharmacy. Octavo volume of 536 pages, 87 full-page plates. Price, 
Cloth, $2.50. 

This work is intended for the beginner and the advanced student, and it fully 
covers the structure of flowering plants, roots, ordinary stems, rhizomes, tubers, 
bulbs, leaves, flowers, fruits, and seeds. Particular attention is given to the gross 
and microscopical structure of plants, and to those used in medicine. Illustra- 
tions have freely been used to elucidate the text, and a complete index to facil- 
itate reference has been added. 

" There is no work like it in the pharmaceutical or botanical literature of this country, and 
we predict for it a wide circulation." — American Journal oj" Pharmacy. 

DIET IN SICKNESS AND IN HEALTH. By Mrs. Ernest Hart, 
formerly Student of the Faculty of Medicine of Paris and of the London 
School of Medicine for Women ; with an Introduction by Sir Henry 
Thompson, F. R. C. S., M. D., London, 220 pages; illustrated. Price, 
Cloth, ^1.50. 

Useful to those who have to nurse, feed, and prescribe for the sick. In 
each case the accepted causation of the disease and the reasons for the special 
diet prescribed are briefly described. Medical men will find the dietaries and 
recipes practically useful, and likely to save them trouble in directing the dietetic 
treatment of patients. 



CATALOGUE OF MEDICAL WORKS. 23 

HOW TO EXAMINE FOR LIFE INSURANCE. By John M. 
Keating, M. D., Fellow of the College of Physicians and Surgeons of 
Philadelphia; Vice-President of the American Paediatric Society; Ex- 
PresKient of the Association of Life Insurance Medical Directors. Royal 
8vo, 211 pages, with two large half-tone illustrations, and a plate prepared 
by Dr. McClellan from special dissections ; also, numerous cuts to elucidate 
the text. Second edition. Price, Cloth, $2.00 net. 

" This is by far the most useful book which has yet appeared on insurance examination, a 
subject of growing interest and importance. Not the least valuable portion of the volume is 
Part II., which consists of instructions issued to their examining physicians by twenty-four 
representative companies of this country. As the proofs of these instructions were corrected 
by the directors of the companies, they form the latest instructions obtainable. If for these 
alone, the book should be at the right hand of every physician interested in this special branch 
of medical science." — The Medical Nevis, Philadelphia. 

NURSING: ITS PRINCIPLES AND PRACTICE. By Isabel 
Adams Hampton, Graduate of the New York Training School for 
Nurses attached to Bellevue Hospital; Superintendent of Nurses and 
Principal of the Training School for Nurses, Johns Hopkins Hospital, 
Baltimore, Md. ; late Superintendent of Nurses, Illinois Training School 
for Nurses, Chicago, 111. In one very handsome i2mo volume of 484 
pages, profusely illustrated. Price, Cloth, $2.00 net. 

This original work on the important subject of nursing is at once comprehensive 
and systematic. It is written in a clear, accurate, and readable style, suitable 
alike to the student and the lay reader. Such a work has long been a desidera- 
tum with those entrusted with the management of hospitals and the instruction of 
nurses in training-schools. It is also of especial value to the graduated nurse 
who desires to acquire a practical working knowledge of the care of the sick 
and the hygiene of the sick-room. 

OBSTETRIC ACCIDENTS, EMERGENCIES, AND OPERA- 
TIONS, liy L. Ch. Bolsi.lNlERE, M. D., late Emeritus Professor of 
Obstetrics in the St. Louis Medical College. 381 pages, handsomely illus- 
trated. Price, I52.00 net. 

•' For the use of the practitioner who, when away from home, has not the 
opportunity of consulting a library or of calling a friend in consultation. He 
then, being thrown upon his own resources, will find this book of benefit in 
guiding and assisting him in emergencies." 

INFANT'S WEIGHT CHART. Designed by J. P. Crozer Griffith, 
M. D., Clinical Professor of Diseases of Children in the University of Penn- 
sylvania. 25 charts in each pad. Price per pad, 50 cents net. 

A convenient blank for keeping a record of the child's weight during the first 
two years of life. Printed on each chart is a curve representing the average weight 
of a healthy infant, so that any deviation from the normal can readily be detected. 



24 W- B. SAUNDERS' 



THE CARE OF THE BABY. By J. P. Crozer Griffith, M. D., 
Clinical Professor of Diseases of Children, University of Pennsylvania; 
Physician to the Children's Hospital, Philadelphia, etc. 392 pages, with 
67 illustrations in the text, and 5 plates. i2mo. Price, $1.50. 

A reliable guide not only for mothers, but also for medical students and 
practitioners whose opportunities for observing children have been limited. 

" The whole book is characterized by rare good sense, and is evidently written by a mas- 
ter hand. It can be read with benefit not only by mothers, but by medical students and by 
any practitioners who have not had large opportunities for observing children." — Ainerican 
Jjurnal of Obstetrics. 

THE NURSE'S DICTIONARY of Medical Terms and Nursing 
Treatment, containing Definitions of the Principal Medical and Nursing 
Terms, Abbreviations, and Physiological Names, and Descriptions 01 the 
Instruments, Drugs, Diseases, Accidents, Treatments, Operations, Foods, 
Appliances, etc. encountered in the ward or in the sick-room. Compiled 
for the use of nurses. By Honnor Morten, author of " How to Become 
a Nurse," "Sketches of Hospital Life," etc. i6mo, 140 pages. Price, 
Cloth, $1.00. 

This little volume is intended for use merely as a small reference-book which 
can be consulted at the bedside or in the ward. It gives sufficient explanation 
to the nurse to enable her to comprehend a case until she has leisure to look up 
larger and fuller works on the subject. 

DIET LISTS AND SICK-ROOM DIETARY. By Jerome B. Thomas, 

M. D., Visiting Physician to the Home for Friendless Women and Children 

and to the Newsboys' Home; Assistant Visiting Physician to the Kings 

County Hospital; Assistant Bacteriologist, Brooklyn Health Department. 

Price, Cloth, $\.^o (Send for specimen List.) 

One hundred and sixty detachable (perforated) diet lists for Albuminuria, 

Ansemia and Debility, Constipation, Diabetes, Diarrhoea, Dyspepsia, Fevers, 

Gout or Uric- Acid Diathesis, Obesity, and Tuberculosis. Also forty detachable 

sheets of Sick-Room Dietary, containing full instructions for preparation of 

easily-digested foods necessary for invalids. Each list is numbered on/y, the 

disease for which it is to be used in no case being mentioned, an index key 

being reserved for the physician's private use. 

DIETS FOR INFANTS AND CHILDREN IN HEALTH AND 
IN DISEASE. By Louis Starr, M. D., Editor of " An American 
Text-Book of the Diseases of Children." 230 blanks (pocket-book size), 
perforated and neatly bound in flexible morocco. Price, j^i.25 net. 

The first series of blanks are prepared for the first seven months of infant 
life- each blank indicates the ingredients, but not the quantrties, of the .ood, 
the 'latter directions being left for the physician. After the seventh month, 
modifications being less necessary, the diet lists are printed in full. Formula 
io- tne preparation of diluents and foods are appended. 




Saunders^ 
New Series 
OF Manuals 



for Students 
and 
Practitioners. 



THAT there exists a need for thoroughly reliable hand-books on the leading 
branches of Medicine and Surgery is a fact amply demonstrated by the 
favor with which the SAUNDERS NEW SERIES OF MANUALS have been 
received by medical students and practitioners and by the Medical Press. 
These manuals are not merely condensations from present literature, but 
are ably written by well-known authors and practitioners, most of them being 
teachers in representative American colleges. Each volume is concisely and 
authoritatively written and exhaustive in detail, without being encumbered 
with the introduction of "cases," w^hich so largely expand the ordinary text- 
book. These manuals will therefore form an admirable collection of advanced 
lectures, useful alike to the medical student and the practitioner: to the latter, 
loo busy to search through page after page of elaborate treatises for what he 
wrants to know, they w^ill prove of inestimable value ; to the former they will 
afford safe guides to the essential points of study. 

The SAUNDERS NEW SERIES OF MANUALS are conceded to be 
superior to any similar books now on the market. No other manuals afford so 
much information in such a concise and available form. A liberal expenditure 
has enabled the publisher to render the mechanical portion of the work worthy 
of the high literary standard attained by these books. 

Any of these Manuals will be mailed on receipt of price (see next page 
for List). 

W. B. SAUNDERS, Publisher, 

925 "Walnut Street, Philadelphia. 



SAUNDERS^ NEW SERIES OF MANUALS. 



VOLUMES PUBLISHED. 



PHYSIOLOGY. By Joseph Howard Raymond, A. M., M. D., Professor 
of Physiology and Hygiene and Lecturer on Gynecology in the Long 
Island College Hospital, etc. Price, $1.25 net. 

SURGERY, General and Operative. By John Chalmers DaCosta, 
M. D,, Demonstrator of Surgery, Jefferson Medical College, Philadelphia, 
etc. Double number. New ajid Enlarged Edition in Preparation. 

DOSE-BOOK AND MANUAL OF PRESCRIPTION-WRITING. 

By E. Q. Thornton, M. D., Demonstrator of Therapeutics, Jefferson 
Medical College, Philadelphia. Price, ^1.25 net. 

MEDICAL JURISPRUDENCE. By Henry C. Chapman, M. D., Pro- 
fessor of Institutes of Medicine and Medical Jurisprudence in the Jeffer- 
son Medical College of Philadelphia, etc Price, $1.50 net. 

SURGICAL ASEPSIS. By Carl Beck, M.D., Surgeon to St. Mark's 
Hospital and to the German Poliklinik ; Instructor in Surgery, New York 
Post-Graduate Medical School, etc. Price, j^i.25 net. 

MANUAL OF ANATOMY. By Irving S. Haynes, M.D., Adjunct 
Professor of Anatomy and Demonstrator of Anatomy, Medical Department 
of the New York University, etc. (Double number.) Price, $2.50 net. 

SYPHILIS AND THE VENEREAL DISEASES. By James 
Nevins Hyde, M. D., Professor of Skin and Venereal Diseases, and 
Frank H. Montgomery, M. D., Lecturer on Dermatology and Genito- 
urinary Diseases, in Rush Medical College, Chicago. (Double number.) 
Price, ^2.50 net. 

PRACTICE OF MEDICINE. By George Roe Lockwood, M. D., 
Professor of Practice in the Woman's Medical College of the New 
York Infirmary, etc. (Double number.) Price, $2.50 net. 

OBSTETRICS. By W. A. Newman Dorland, M. D., Asst. Demonstrator 
of Obstetrics, University of Pennsylvania ; Chief of Gynecological Dispen- 
sary, Pennsylvania Hospital. (Double number.) Price, $2.50 net. 

DISEASES OF WOMEN. By J. Bland Sutton, F. R. C. S., Assistant 
Surgeon to the Middlesex Hospital, and Surgeon to the Chelsea Hospital 
for Women, London; and Arthur E. Giles, M. D., B. Sc. Lond., 
F. R. C. S. Edin., Assistant Surgeon to the Chelsea Hospital for Women, 
London. 436 pages, handsomely illustrated. (Double number.) Price, 
$2.50 net. 

VOLUMES IN PREPARATION. 

NERVOUS DISEASES. By Charles W. Burr, M. D., Clinical Pro- 
fessor of Nervous Diseases, Medico-Chirurgical College, Philadelphia, etc. 

NOSE AND THROAT. By D. Braden Kyll, M. D., Chief Lar>-ngolo- 
gist to St. Agnes' Hospital, Philadelphia ; Instructor in Clinical Microscopy 
and Assistant Demonstrator of Patholog}' in Jefferson Medical College. 

%* There will be published in the same series, at sh^rt intervals, carefully 
prepared works on various subjects, by prominent specialists. 



SAUNDERS' QUESTION COMPENDS. 

Arranged in Question and Answer Form. 

THE LATEST, MOST COMPLETE, and BEST ILLUSTRATED 
SERIES OF COMPENDS EVER ISSUED. 



Now the Standard Authorities in Medical Literature 



Students and Practitioners in every City of the United 
States and Canada. 



THE REASON WHY. 

They are the advance guard of ** Student's Helps " — that do help; they are 
the leaders in their special line, we// and authoritative/y written by ab/e men^ 
who, as teachers in the /arge co//eges, know exact/y what is wanted by a student 
preparing for his examinations. The judgment exercised in the selection of 
authors is fully demonstrated by their professional elevation. Chosen from the 
ranks of Demonstrators, Quiz-masters, and Assistants, most of them have be- 
come Professors and Lecturers in their respective colleges. 

Each book is of convenient size (5x7 inches), containing on an average 250 
pages, profusely illustrated, and elegantly printed in clear, readable type, on 
fine paper. 

The entire series, numbering twenty- four subjects, has been kept thoroughly 
revised and enlarged when necessaiy, many of them being in their fourth and 
fifth editions. 

TO SUM UP. 

Although there are numerous other Quizzes, Manuals, Aids, etc. in the mar- 
ket, none of them approach the " Blue Series of Question Compends;" and 
the claim is made for the following points of excellence : 

1. Professional distinction and reputation of authors. 

2. Conciseness, clearness, and soundness of treatment. 

3. Size of type and quality of paper and binding. 

V- Any of these Compends will toe mailed on receipt of price (see over 
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Antiseptic Surgery. 90 illustrations. By Edward Martin, M. D. 

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illustrations. By Charles B. Nancrede, M, D. 

4. ESSENTIALS OF MEDICAL CHEMISTRY, ORGANIC AND 

INORGANIC. 4th edition, revised, with an Appendix. By Law 
rence Wolff, M. D. 

5. ESSENTIALS OF OBSTETRICS. 4th edition, revised and en- 

larged. 75 illustrations. By W. Easterly Ashton, M. D. 

6. ESSENTIALS OF PATHOLOGY AND MORBID ANATOMY. 

7th thousand. 46 illustrations. By C. E. Armand Semple, M. D. 

7. ESSENTIALS OF MATERIA MEDICA, THERAPEUTICS, 

AND PRESCRIPTION-WRITING. 4th edition. By Henry 
Morris, M. D. 

8. 9. ESSENTIALS OF PRACTICE OF MEDICINE. By Henry 

Morris, M. D. An Appendix on Urine Examination, Illustrated. 
By Lawrence Wolff, M. D. 3d edition, enlarged by some 300 Es- 
sential Formulae, selected from eminent authorities, by Wm. M. Powell, 
M. D. (Double number, price $2.00.) 

10. ESSENTIALS OF GYNiECOLOGY. 4th edition, revised. With 

62 illustrations. By Edwin B. Cragin, M. D. 

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vised and enlarged. 71 letter-press cuts and 15 half-tone illustrations. 
By Henry W. Stelwagon, M. D. (Price, ^i.oo net.) 

12. ESSENTIALS OF MINOR SURGERY, BANDAGING, AND 

VENEREAL DISEASES. 2d edition, revised and enlarged. 78 
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13. ESSENTIALS OF LEGAL MEDICINE, TOXICOLOGY, AND 

HYGIENE. 130 illustrations. By C. E. Armand Semple, M. D. 

14. ESSENTIALS OF DISEASES OF THE EYE, NOSE, AND 

THROAT. 124 illustrations. 2d edition, revised. By Edward 
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15. ESSENTIALS OF DISEASES OF CHILDREN. Second edi 

tion. By William H. Powell, M. D. 

16. ESSENTIALS OF EXAMINATION OF URINE. " Colored 

" Vogel Scale," and numerous illustrations. By Lawrence Wolff, 
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17. ESSENTIALS OF DIAGNOSIS. By S. Solis-Cohen, M. D., and 

A. A. Eshner, M. D. 55 illustrations, some in colors. (Price, $1 .50 net.) 

18. ESSENTIALS OF PRACTICE OF PHARMACY. By L. E. 

Sayre. 2d edition, revised. 

20. ESSENTIALS OF BACTERIOLOGY. 3d edition. 82 illustra- 

tions. By M. V. Ball, M. D. 

21. ESSENTIALS OF NERVOUS DISEASES AND INSANITY. 

48 illustrations. 3d edition, revised. By John C. Shaw, M. D. 

22. ESSENTIALS OF MEDICAL PHYSICS. 155 illustrations. 2d 

edition, revised. By Fred J. Brockway, M. D. (Price, Si.oo net.) 

23. ESSENTIALS OF MEDICAL ELECTRICITY. 65 illustrations. 

By David D. Stewart, M. D., and Edward S. Lawrance, M. D. 

24. ESSENTIALS OF DISEASES OF THE EAR. By E. B. Glea^ 

SON, M. D. 114 illustrations. Second edition, revised and enlarged. 



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PENROSE'S DISEASES OF WOMEN 

A Text=Book of Diseases of Women. By Charles B. Penrose, M.D., Ph.D., 
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SENN'S GENITO=URINARY TUBERCULOSIS 

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Surgery, Rush Medical College, Chicago. Handsome octavo volume of 320 pages, 
illustrated. Cloth, $3.00 net. 

SUTTON AND GILES* DISEASES OF WOMEN 

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sex Hospital, and Surgeon to Chelsea Hospital, London; and Arthur E. Giles, 
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436 pages, handsomely illustrated. Cloth, ^2.50 net. 

BUTLER'S MATERIA MEDICA, THERAPEUTICS, AND PHAR= 
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A Text-Book of Materia Medica, Therapeutics, and Pharmacology. By George 
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Lectures on Renal and Urinary Diseases. By Robert Saundbv. M.D. Edin., 
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PYE'S BANDAGING 

Elementary Bandaging and Surgical Dressing, with Directions Concerning 
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I Pathological Technique. By Frank B. Mallorv, A.M., M.D., Assistant Professor 

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\ ANDERS' PRACTICE OF MEDICINE 

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29 



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ANOMALIES 

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CURIOSITIES OF MEDICINE. 

BY 

GEORGE M. GOULD, M. D., and WALTER L. PYLE, M. D. 

Several years of exhaustive research have been spent by the authors in the 
great medical libraries of the United States and Europe in collecting the material 
for this work, iledical literature of all ages and all languages has 
been carefully searched, as a glance at the Bibliographic Index will show. Ths 
facts, which will be of extreme value to the author and lecturer, have 
been arranged and annotated, and full reference footnotes given, indicating 
whence they have been obtained. 

In view of the persistent and dominant interest in the anomalous and curious, 
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authors have knowledge) must have its own peculiar sphere of usefulness. 

As a complete and authoritative Book of Reference it will be of value 
not only to members of the medical profession, but to all persons interested in 
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An especially valuable feature of th€ book consists of the Indexing. 
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more important reports, there is a convenient Bibliographic Index and a 
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The plan has been adopted of printing the topical headings in bold= 
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The careful rendering of the text and references, the wealth of illustrations, 
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Handsome Imperial Octavo Volume of 968 Pages. 
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AN AMERICAN TEXT=BOOK OF GENITO=URINARY AND SKIN 
DISEASES 

Edited by L. Bolton Bangs, M.D., Late Professor of Genito-Urinary and Venereal 
Diseases, New York Post-Graduate Medical School and Hospital; and William 
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Octavo volume of over 1200 pages, with 300 illustrations in the text, and 20 full-page 
colored plates. Prices : Cloth, $7.00 net ; Sheep or Half Morocco, |8.oo net. 

MOORE'S ORTHOPEDIC SURGERY 

A Manual of Orthopedic Surgery. By James E. Moore, M.D., Professor of Ortho- 
pedics and Adjunct Professor of Clinical Surgery, University of Minnesota, College 
of Medicine and Surgery. 8vo, 356 pages, handsomely illustrated. Cloth, $2.50 net. 

MACDONALD'S SURGICAL DIAGNOSIS AND TREATMENT 

Surgical Diagnosis and Treatment. By J. W. Macdonald, M.D. Edin., L.R.C.S. 
Edin., Professor of the Practice of Surgery and of Clinical Surgery in Hamline Uni- 
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CHAPIN ON INSANITY 

A Compendium of Insanity. By John B. Chapin, M.D., LL.D., Physician-in-Chief, 
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KEEN ON THE SURGERY OF TYPHOID FEVER 

The Surgical Complications and Sequels of Typhoid Fever. By Wm. W. Keen, 
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VAN VALZAH AND NISBET'S DISEASES OF THE STOMACH 

Diseases of the Stomach. By William W. van Valzah, M.D., Professor of General 
Medicine and Diseases of the Digestive System and the Blood, New York Polyclinic ; 
and J. Douglas Nisbet, M.D., Adjunct Professor of General Medicine and Diseases 
of the Digestive System and the Blood, New York Polyclinic. Octavo volume of 674 
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IN PREPARATION 

AN AMERICAN TEXT=BOOK OF DISEASES OF THE EYE, EAR, 
NOSE, AND THROAT 

Edited by G. E. de Schweinitz, M.D., Professor of Ophthalmology in the Jefferson 
Medical College; and B. Alexander Randall, M.D., Professor of Diseases of the 
Ear in the University of Pennsylvania and in the Philadelphia Polyclinic. 

CHURCH AND PETERSON»S NERVOUS AND MENTAL DISEASES 

Nervous and Mental Diseases. By Archibald Church, M.D., Professor of Mental 
Diseases and Medical Jurisprudence, Northwestern University Medical School, 
Chicago; and Frederick Peterson, M.D. , Clinical Professor of Mental Diseases, 
Woman's Medical College, New York, etc. 

KYLE ON THE NOSE AND THROAT 

Diseases of the Nose and Throat. By D. Braden Kyle, M.D., Clinical Professor 
of Laryngology and Rhinology, Jelferson Medical College, Philadelphia; Consulting 
Laryngologist, Rhinologist, and Otologist, St. Agnes' Hospital, etc. 

STENGEL'S PATHOLOGY 

A Manual of Pathology. By Alfred Stengel, M.D., Physician to the Philadel- 
phia Hospital; Professor of Clinical Medicine in the Woman's Medical College; 
Physician to the Children's Hospital, etc. 

HIRST'S OBSTETRICS 

A Text=Book of Obstetrics. By Barton Cooke Hirst, M.D., Professor of Ob 

stetrics, University of Pennsylvania. 

HEISLER'S EMBRYOLOGY 

A Text=Book of Embryology. By John C. Heisler, M.D., Professor of Anatomy, 
Medico-Chirurgical College, Philadelphia. 



NOW HEADY, VOLUMES FOn 1896,1897,1898. 



AMERICAN YEAR-BOOK OF MEDICINE and SURGERY, 

Edited by GEORGE M. GOULD, A.M., M. D. 
Assisted by Eminent American Speoialiots and Teachers. 



^ Notwithstanding the rapid multiplication of medical and surgical works, 

C still these publications fail to meet fully the requirements of the general physician^ ^ 

^ inasmuch as he feels the need of something more than mere text -books of well- "^^ 

g known principles of medical science. Mr. Saunders has long been impressed ^ 

^ with this fact, which is confirmed by the unanimity of expression from the pro- ^ 

S fession at large, as indicated by advices from his large corps of canvassers. ^ 

fe This deficiency would best be met by current journalistic literature, but most ^ 

"o^ practitioners have scant access to this almost unlimited source of information, «. 

S and the busy practiser has but little time to search out in periodicals the many c^ 

§ interesting cases whose study would doubtless be of inestimable value in his ;: 

© practice. Therefore, a work which places before the physician in convenient h^ 

^ form an epitomization of this literature by persons competent to pronounce upon 5 

§ The Value of a Discovery or of a Method of Treatment X 

«» cannot but command his highest appreciation. It is this critical and judicial ^ 

.^ function that will be assumed by the Editorial staff of the " American Year- 

f^ Book of Medicine and Surgery." ^ 

g It is the special purpose of the Editor, whose experience peculiarly qualifies «. 

§ him for the preparation of this work, not only to review the contributions to ^j 

American journals, but also the methods and discoveries reported in the leading § 

ti medical journals of Europe, thus enlarging the survey and making the work ^ 

» characteristically international. These reviews will not simply be a series of 

§ undigested abstracts indiscriminately run together, nor will they be retrospective » 

^ of " news " one or two years old, but the treatment presented will be synthetic 

'^ and dogmatic, and will include only what is new. Moreover, through expert 

^ condensation by experienced writers these discussions will be 

Comprised in a Single Volume of about 1200 Pages. 

The work will be replete with original and selected illustrations skilfully 
reproduced, for the most part in Mr. Saunders' own studios established for the 
purpose, thus ensuring accuracy in delineation, affording efficient aids to a right 
comprehension of the text, and adding to the attractiveness of the volume. 
Prices : Cloth, $6.50 net; Half Morocco, I7.50 net. 

W. B. SAUNDERS, Publisher, 

^^ 925 Walnut Street, Philadelphia. 



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